Laserfiche WebLink
MAR-13-1997 08:31 FROM PUBLIC HEALTH SERVICES TO 94640133 P.03 <br /> San Josqula County Public Health <br /> Fhvlronmental Health Dhrl" <br /> Medical Waste M ether. PMram f"' <br /> APPLICATION FOR A VAITF.D QUANTITY HAULM MMMPTION <br /> To quWry for a'E.trrdtad Quentity HauRM Ememptitrrt'pummel b the"NlWlcai V*m to MW%-gement AX,the blowing <br /> modwris owd be mei . <br /> 'ftw germrator or health rare prafeeaidnat genen*m le9S tt=20 pounds of nWkWd wafe per week, transpottf;to <br /> rhan 20 pounds of rnedicei wmba at arty one time, malt a buNng dooumscit pWsuwd to Char 6, and the <br /> generatior or pwat cxgani*W"tag on Mei one of Mer following: <br /> 1- M ftqe lt+larragmmt Pan v V*vsr*=W or iwM amen is a large g4:antity generator or a=0 <br /> quantify qwmvW mgt*W to twister petrdttttttt to Chapter 4. <br /> 2 lnfwma6arr Docurm t ff the ger or parent ra gwilzadott k a small gsmrrtity gerver-abr not required to <br /> mgtster pumelnt b C PW 4. <br /> p'LME COMPLETE TM INFORMATION BELOW AND MAIL WRH IIS'FEE TO: <br /> Sen Jo:quirr C XU* PWAiG Health Services <br /> Environmental Health Dlvlsion <br /> Medical Wade Managenilm # Pt gmm <br /> 3D4 E Weber Aire <br /> Stockton, CA 95202 <br /> Medical dical Wmts Hauler lrai numllon <br /> Q New V Renewal <br /> Modkd Me ftslrt m Noma: Si7 A- u.,VU u, P c a.,a t-.. e— <br /> Modbal 0Wm1DU nese IJZ121 <br /> c. -i ghtba: �', alp E a- - <br /> torr: Phom A a.k.t}' - 25 3 4 4 <br /> Storage Faditj Mane: „Pt PJ bra(A �1���v�'Y „ �t-'�'i•C- 1-4c-k tit-i-+ g."- <br /> storm"FaCiq�f <br /> PWmitibed Traattrm..r�entt FaCiFm*Nem, S n f-g" yy — h 7 i rya r-, m e mim `s <br /> PEjr nt ted i" r Atha a k t I . i oi ■ �i <br /> C*; <br /> W of empbyse nsmm and titles authorixsd to ftwood thr rya Azd wa48.If nvt a WAO tom.> kvkw naum <br /> t.. ; <br /> 2- N" a_r-k--4L.f- fie: <br /> '.M <br /> A cow of dft eeempeen and s*W*tap d=xml t sial/be In en+preyeON 10 811 #It*1 lel yrs wtclle tr -q medkg rrnsis in <br /> addidom,at*Wn or m@MW wow vftw&mW be kept on AN at uWalmWs or hNft we W0ft=W9W*' qr. <br /> Applicant Sipv"�. <br /> _Date- -Z! f i� 7 <br /> Cao Not Writs Below'this Liner <br /> LE M.&Appikelon Approval: <br /> M4= 1"3-% Date Paid ec �° Gah or Mede (cimie} Am <br />