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SANJ O A Q U I N Environmental Health Department <br /> - COUNTY-__ _ <br /> Registration for Generators of Medical Waste <br /> Generator Name: BioLife Plasma Services, LP <br /> Generator Facility Address: 1125 W March Ln <br /> Stockton CA 95207 <br /> City State Zip Code <br /> Phone Number: ( 470 )352-3338 <br /> Generator Mailing Address: 1125 W March Ln, Stockton, CA 95207 <br /> City State Zip Code <br /> Type of Business: Plasma Collection Center (Plasmapheresis) <br /> Authorized Representative: Brian Stokes <br /> Title: Center Manager <br /> Emergency Phone Number: ( 877 )432-5820 <br /> Registration for: <br /> ❑ Small Quantity Generator with Onsite Treatment (Generates less than 200 lbs/month). <br /> ® Large Quantity Generator Only (Generates 200 lbs or more/month). <br /> ❑ Large Quantity Generator with Onsite Treatment (Generates 200 lbs or more/month). <br /> I declare under penalty of law that to the best of my knowledge and belief the statements <br /> made herein are correct and true. I hereby consent to all necessary inspections made <br /> pursuant to the California Medical Waste Management Act and incidental to the issuance of <br /> this registration a�d the oper tion of this business. <br /> Signature`.' /i Itle:Center Manager Date: <br /> 4of8 <br />