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Get CA CDPH 8550 2015-2024

O. Box 997377 Sacramento CA 95899-7377 CDPH 8550 1/2015 Generator Registration Or courier to 1616 Capitol Ave. State of California Health and Human Services Agency California Department of Public Health California Medical Waste Management Program Generator Registration Application Facility Name County Address number street City ZIP code Mailing address if different from above Telephone Fax Email Address s Consult with CDPH prior to applying if you are unsure if CDPH is the enforcement agency for medical waste in your county. Application Type Small Quantity Generator SQG Your facility generates less than 200 pounds of medical waste per month. Large Quantity Generator LQG Your facility generates 200 pounds or more of medical waste per month. New applicants must submit a copy of your facility s Medical Waste Management Plan* Change of ownership Registration number Types of waste your facility may generate Biohazardous sharps pharmaceutical chemotherapy pathology. Our waste is Picked up by a registered transporter name Refer to our website for a list of authorized haulers http //www. cdph. ca*gov/certlic/medicalwaste/Pages/Transporters. aspx Mailed via Mail-Back System name Treated onsite by autoclave or by alternative treatment method A LQG treating waste onsite shall apply for a permit with Form 8706. A SQG treating waste onsite autoclave only shall register with Form 8705. Both applications are available at I certify under penalty of perjury that the information contained in this application is true and accurate to the best of my knowledge and belief* Authorized Representative Signature Title Date The fee page is available at http //www. cdph. ca*gov/pubsforms/forms/CtrldForms/cdph8662. pdf Make the check payable to the Medical Waste Management Fund* Mail the application and fee to Medical Waste Management Program MS 7405 P. State of California Health and Human Services Agency California Department of Public Health California Medical Waste Management Program Generator Registration Application Facility Name County Address number street City ZIP code Mailing address if different from above Telephone Fax Email Address s Consult with CDPH prior to applying if you are unsure if CDPH is the enforcement agency for medical waste in your county. Application Type Small Quantity Generator SQG Your facility generates less than 200 pounds of medical waste per month. Application Type Small Quantity Generator SQG Your facility generates less than 200 pounds of medical waste per month. Large Quantity Generator LQG Your facility generates 200 pounds or more of medical waste per month. Large Quantity Generator LQG Your facility generates 200 pounds or more of medical waste per month. New applicants must submit a copy of your facility s Medical Waste Management Plan* Change of ownership Registration number Types of waste your facility may generate Biohazardous sharps pharmaceutical chemotherapy pathology. New applicants must submit a copy of your facility s Medical Waste Management Plan* Change of ownership Registration number Types of waste your facility may generate Biohazardous sharps pharmaceutical chemotherapy pathology. Our waste is Picked up by a registered transporter name Refer to our website for a list of authorized haulers http //www. .

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