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SA N J 0 A O U I N Environmental Health Department <br /> . COUNTY— <br /> Certification Statement for Operators not required to Register <br /> Facility Name: <br /> �e >S e��r� Det+ <br /> Facility Address: I Ike- <br /> City, State, Zip Code: <br /> Phone Number: O <br /> oMTV CS b C p7o x <br /> fyoa <br /> Facility Contact and Title: a <br /> My facility is not required to register with the San Joaquin County Environmental Health Department <br /> because (check the appropriate statements): <br /> ❑ My facility does not generate regulated medical waste. <br /> My facility generates less than 200 pounds per month and does not treat regulated medical <br /> waste. <br /> My facility is not a common storage facility of regulated medical waste. <br /> declare under penalty of law that to the best of my knowledge and belief the statements made herein <br /> are correct and true. <br /> I�-�Y� i CS u <br /> Signature: <br /> Name and and Title: <br /> Date: <br /> Version:7-1-25 Page 2 of 11 <br />