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ENVIRONMENTAL HEAL TH DEPARTMENT <br /> SAN JOAQUIN COUNTY <br /> 1868 E.Hazelton Avenue <br /> Stockton,California 95205 <br /> Telephone: (209)468-3420 <br /> Fax: (204)468-8392 <br /> GUIDELINES FOR THE MEDICALAT NAGE NT PLAN <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 flan shall contain the following information as appropriate for your <br /> facility: <br /> Business Name: <br /> o � if <br /> Business Address: goo ft, e, <br /> Lo Aj <br /> q-5 a 4 2_ <br /> city State Zip Code <br /> Phone Number: (zog } 3 (o "µ 1 l <br /> Type of Facility or Business: 44ow t/ <br /> REGISTRATION-FOR:-- <br /> Small <br /> IST TI -FO :-'Small Quantity Generator with Onsite Treatment(Generates less than 200 lbs/month). <br /> Large Quantity Generator Only(Generates 200 lbs or morelmonth). <br /> ❑ Large Quantity Generator with Onsite Treatment(Generates 200 lbs or more/month). <br /> Person responsible for implementation of the Medical Waste Management Plan: <br /> Name: Title: !lie e h-, <br /> Phone: —1 —Date: <br /> 1. List the types of medical waste generated at your facility(i.e.laboratory wastes,blood or body <br /> fluids, sharps,contaminated anneals,surgic specimens, tri e hemo or isolati wastes): <br /> a)Do you generate M pharmaceutical waste(expired, spent,partials,patient returns)? LA Yes ❑No <br /> If yes, d'sccrib the type of pharmacept, al waste(expired, sp nt,partials,patient returns): <br /> And estimate the monthly amount of pharmaceutical waste generated at your facility: ®®, `"" <br /> EHD 45-03 5 <br /> 2015 <br />