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SANJ O A Q U I N Environmental Health Department <br /> COUNTY <br /> Certification Statement <br /> FOR NON-MEDICAL WASTE GENERATORS AND MEDICAL WASTE GENERATORS NOT <br /> REQUIRED TO REGISTER <br /> Business Name: Kaiser Permanente Foundation Hospitals <br /> Business Address: 1 17000 S Harlan Road <br /> Lathrop, Ca 95330 <br /> City State Zip Code <br /> Phone Number: 209 275-9160 <br /> Contact Person: Chandra Buchanan <br /> I am not required to register as a Medical Waste Generator because: <br /> Please check the appropriate statement(s) <br /> ❑ I do not generate any medical waste. <br /> I generate less than 200 pounds of medical waste per month. <br /> I do not treat any medical waste at my facility by means of autoclaving, incinerating or <br /> microwaving. <br /> ❑ Other: <br /> Please indicate the appropriate statement(s): <br /> xMx I declare under penalty of law that to the best of my knowledge and belief, I do not generate or <br /> store any of the wastes specified on the `Pre-Application Questionnaire" as regulated <br /> medical wastes in an amount that equals or exceeds 200 pounds per month. <br /> declare under penalty of law that I will not be treating any amount of -egulated medical wastes <br /> at my facility by way of autoclaving, incinerating or microwaving. <br /> Signature: <br /> aW'_a Buc%a7a71 llfl , ef'4"4tle: Date:Safety Operations Practice Leader 3/30/23 <br /> 4of11 <br />