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Environmental Health be artment <br /> SAN J0AQUIN p <br /> -- " COUNTY j <br /> Medical Waste Facility Registration <br /> Facility Name : S '' " u—y' <br /> FacilityAddress : y � a � ' Y %! tt. <br /> .� <br /> i <br /> City , State , Zip Code : ' ( <br /> Mailing Address : C, hmc� <br /> City , State , Zip Code : <br /> Phone Number: <br /> Facility Contact and Title : rc- ► }2 ? C��j°iLL !J y �' a - ' ��tr lflcj, n tTi/W <br /> Facility Registration Category: <br /> ❑ Small Quantity Generator (<200 pounds per month ) with Onsite Treatment, <br /> I Large Quantity Generator (> = 200 pounds per month ) with Onsite Treatment . <br /> ❑ Large Quantity Generator (> =200 pounds per month) without Onsite Treatment . <br /> ❑ Common Storage Facility (2- 10 generators ) <br /> ❑ Common Storage Facility ( 11 -50 generators ) <br /> ❑ Common Storage Facility ( > 50 generators) <br /> 3of11 <br />