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L] <br />lu"FLED 131M-17471 C12111�-& Ummurer <br />(Please Type or Print) <br />Small quantity generators that provide onsite treatment and all large quantity generato4q <br />shall have a medical waste management plan on file with the local enforcement agen <br />(PHS-EHD). The medical waste management plan shall contain the following informatio <br />as appropriate for your facility: I <br />Business Name: Lodi Mem rjal Hosoj.�al East <br />Business Address: 975 S. Fairmont P.O. Box 3004 <br />Business Phone: 209 )334 3411 <br />Type Of Facility Or Business: General Acute Care Hospital <br />Registered As: (Check One) <br />Small Quantity Generator With Onsite Treatment. (Generates < 200 lbs./mo.) <br />Large Quantity Generator. (Generates 200 lbs. or ore/ o.) <br />0) Large Quantify Generator With Onsite Treatment. (Generates 200 lbs. or ores o.) <br />Person Responsible For Implementation Of The Plan: <br />Title: Administrator - Phone: X209 3 4 3411 Ext 7560 <br />I List the types of medical waste generated at your facility, i.e., Laboratory Wastes, <br />Blood or Body Fluids, Sharps, Contaminated Animals, Surgical Specimens, or <br />Isolation Wastes. (See "D-gulated Medical Wastes" on Page 3.) <br />See Attachment'r <br />2. Estimate the monthly amount of medical waste generated at your facility. <br />Approximately 4800 pounds autoclaved and 350 pounds sent to offsite treatment <br />3. Describe the medical waste handling procedures utilized by and applicable to your <br />facility: <br />2. Onsite location and method for segregation, containment, packaging, <br />labelling, and collection. See Attachment B <br />-CONTINUED ON REVERSE - <br />N <br />