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Phone: <br /> 7J— <br /> g. Name,address and phone number of Offsite Treatment Facility where pharmaceutical <br /> waste is transported for treatment,if different than pharmaceutical waste hauler: <br /> Name: <br /> Address: U t U S' A611-;j j'-�2 f J <br /> City State Zip Code <br /> Phone: <br /> h. All medical waste generators are required to keep accurate records regarding <br /> containment,storage,hauling,treatment and disposal. All medical waste records area to <br /> be maintained and available for review during inspection for three(3)years. Do you <br /> have tracking documents for all medical wastes handled at your facility: es®No <br /> i. Describe training provided to staff regarding handling,storage,disposal,and record <br /> keeping of all medical waste,including pharmaceutical waste,at your facility: <br /> r tt'1t" - ctt�e' Cir-err�,fr� rC C' O-eaVIry- <br /> e <br /> j. Describe your medical waste emergency action plan, including procedures for <br /> handling spills,exposures,equip hent failures, etc: <br /> t CU ,t'_ G ) <br /> I hereby certify to the best of my knowledge and belief that the statements made herein are <br /> correct and true. <br /> Signature: (OY, <br /> Printed Name: `7j <br /> OLA- <br /> Title: C �•�Cd�zll�' ' <br /> Date: LCrg f 2 Gi , 4C)l <br /> S- <br /> EHD 45-03 ��T�- Q t ' ev. <br />