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06/03/2005 14:10 4640:.38 ENVIRONMENTAL HEALTH PAGE 02 <br /> 17 <br /> r-4,NVIRONMENTAL HEALTH DEPARTMENT <br /> SAN JOAQUIN COUNTY <br /> 304 East Weber Avenue, Third Floor <br /> Stockton,Califomia 95202 <br /> Telephone: (209) 468-3420 <br /> Fax: (209)465--3433 <br /> GUIDELINES FOR THE MEDICAL WASTE MANAGEMENT FLAN <br /> Small quantity generators that provide Onsite Treatment and all large quantity generators shall have a <br /> Medical Waste Management plan on file with the San Joaquin County Environmental Health Department. <br /> The Medical Waste Management Plan shall contain the following information as appropriate for your <br /> facility: <br /> • � a <br /> Business Nance: <br /> Business Address: <br /> City state Zip Cade <br /> Phone Number: — a2 3P` a <br /> Type of Facility or.Business: <br /> REGISTRATION FOR: <br /> Small Quantity Generator with Onsite Treatment (Generates less than 2001bs/month). <br /> ❑ Large Quantity Generator Only (Generates 200 lbs or more/morith). <br /> ❑ <br /> Large Quantity Generator with Onsite Treatment (Generates 200 lbs or more/month). <br /> Person responsible for implementation of the Medical Waste Management Plan: e� <br /> Name: �- Title: i)ir� 17 �� 00)14,-0 <br /> lame: �. "� �. r i AQ V° <br /> Phone: --/ Date: I <br /> 1. List the types of medical waste generated at your facility. i.e., laboratory wastes, blood or body <br /> fluids,shams, contaminated anintials, surgical specimens, trace chewo or isolation w rtes": <br /> &Aj ® r� <br /> a)Do you generate any pharmaceutical waste(expired, spent,partials, outdated)? ❑ Yes ❑No <br /> IcNG 45-03 Page 1 <br /> 6�S:o5 <br />