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GUIDELINES FOR THE MEDICAL WASTE MANAGEMENT <br /> PLAN <br /> Small quantity generators that provide Onsite Treatment and all large quantity generators <br /> shall have a Medical Waste Management plan on file with the San Joaquin County <br /> Environmental Health Department. The Medical Waste Management Plan shall contain the <br /> following information as appropriate for your facility: <br /> Business Name: flit ! <br /> A ZA <br /> 4 <br /> L <br /> /1 � ` / l� !` /eBusiness Address: zy �.t,� /0/ <br /> c !� � -7 <br /> City St to Zip Code <br /> Phone Number: 3Z3� """ Q <br /> Type of Facility or Business:— <br /> RE GISTRATION <br /> usiness:REGISTRATION FOR: <br /> ❑ Small Quantity Generator with Onsite Treatment(Generates less than 200lbs/month). <br /> Large Quantity Generator Only(Generates 200 lbs or ntore/month). <br /> /❑ Large Quantity Generator with Onsite Treatment(Generates 200 lbs or morehnonth). <br /> Person responsible for implementation of the Medical Waste Management Plan: <br /> Name: � Title: o/U <br /> Phone: 2 04 Date: <br /> 1. List the types of medical waste generated at your facility,i.e.,laboratory wastes,blood or body <br /> fluids,sharps,contaminated animals,surgical specimens,trace chemo or isolation wastes" <br /> 13f(?ct� <br /> a) Ido you generate a�pharmaceutical waste(expired/outdated,spent,partials,)? <br /> b) Xr,AJ Yes <br /> F]No <br /> If yes,describe the type of plrar•maceutical waste(expired,spent,partials,outdated,patient <br /> returns,etc): <br /> t�X-C t5 <br /> And estimate the monthly amount of pharmaceutical waste generated at your <br /> facility: fi 4 <br /> EHD 45-03 5 <br /> 10/6/2006 <br />