Form Cdph 8550 – Fill Out and Use This PDF

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	Telephone
			(	)
Mailing address (if different from above)	City	ZIP code	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:____________________

∙Refer to our website for mail back information http://www.cdph.ca.gov/certlic/medicalwaste/Pages/MailBack.aspx

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: http://www.cdph.ca.gov/cert/medicalwaste

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.

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.

CDPH 8550 (1/2015) Generator Registration