Form CDPH8706 "Large Quantity Generator With Onsite Treatment Permit Application - Medical Waste Management Program" - California

What Is Form CDPH8706?

This is a legal form that was released by the California Department of Public Health - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 1, 2018;
  • The latest edition provided by the California Department of Public Health;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CDPH8706 by clicking the link below or browse more documents and templates provided by the California Department of Public Health.

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Download Form CDPH8706 "Large Quantity Generator With Onsite Treatment Permit Application - Medical Waste Management Program" - California

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State of California—
California Department of Public Health
Health and Human Services Agency
Medical Waste Management Program
Large Quantity Generator with Onsite Treatment
Permit Application
Facility
Facility Name:
County*:
Street Address:
City:
Zip Code:
Mailing Address (if different from above):
City:
Zip Code:
Telephone:
Email:
*Consult with CDPH prior to applying if you are unsure if CDPH is the enforcement
agency for medical waste in your county.
Type of Treatment
Steam sterilization
Brand:
Model:
Related capacity/cycle:
Average Monthly Quantity of Waste Treated:
Other treatment type*:
*Alternative technology treatment methods approved by CDPH do not require an onsite
treatment permit.
Type of Application
New*
Renewal
Transfer of Facility Ownership
Revision
Existing LQG# (if applicable):
*For new permits, the Department must approve the permit application prior to the
facility treating medical waste. The permit is valid for 5 years. Ninety (90) days prior to
the expiration date, the applicant shall file for renewal of the permit.
Certification
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:
Title:
Signature:
Date:
CDPH 8706 (6/18)
Page 1 of 2
State of California—
California Department of Public Health
Health and Human Services Agency
Medical Waste Management Program
Large Quantity Generator with Onsite Treatment
Permit Application
Facility
Facility Name:
County*:
Street Address:
City:
Zip Code:
Mailing Address (if different from above):
City:
Zip Code:
Telephone:
Email:
*Consult with CDPH prior to applying if you are unsure if CDPH is the enforcement
agency for medical waste in your county.
Type of Treatment
Steam sterilization
Brand:
Model:
Related capacity/cycle:
Average Monthly Quantity of Waste Treated:
Other treatment type*:
*Alternative technology treatment methods approved by CDPH do not require an onsite
treatment permit.
Type of Application
New*
Renewal
Transfer of Facility Ownership
Revision
Existing LQG# (if applicable):
*For new permits, the Department must approve the permit application prior to the
facility treating medical waste. The permit is valid for 5 years. Ninety (90) days prior to
the expiration date, the applicant shall file for renewal of the permit.
Certification
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:
Title:
Signature:
Date:
CDPH 8706 (6/18)
Page 1 of 2
Waste Plan
Provide a Medical Waste Management Plan, per the Medical Waste Management Act of
the Health and Safety Code; §117960(a-k). For permit renewals: do not include a Plan,
unless significant revisions have been made since the facility’s last inspection.
Facility Site Map
For new permits, provide a map extending for one mile beyond the property boundary,
including access roads, residential development, schools, etc. Additionally, provide a
drawing of the treatment unit area and outside storage area.
Mailing Instructions and Fees
The fee for a new permit can be found
on CDPH Form
8662.
(https://cdph.ca.gov/CDPH%20Document%20Library/ControlledForms/cdph8662.pdf).
Please make the check payable to the Medical Waste Management Fund. There is no
fee for a revised permit or transfer of ownership.
Mail the application and fee to:
Or courier to:
California Department of Public Health
California Department of Public Health
Medical Waste Management Program
Medical Waste Management Program
1725 23rd St, Ste 110
MS 7405, IMS K-2
Sacramento, CA 95816
P.O. Box 997377
Sacramento, CA 95899-7377
CDPH 8706 (6/18)
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