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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 Mutagerrtent plan on file with the San Joaquin County <br /> Environmental health Department. The Medical Waste Management Plan shall contain the <br /> Collowing information its appropriate for your facility: <br /> Business Name: �,�/,CS /P/d <br /> Business Address:_5 �: t,?a <br /> IS-r-0 �'A/- <br /> City State Zip Code <br /> Phone Number: ( 076f ) <br /> Type of Facility or Business: <br /> REGISTRATION FOR: <br /> ❑ Small Quantity Generator with Onsite Treatment(Generates less than 200lbs/month). <br /> Large Quantity Generator Only((jenerdics 200 Ihs or more/month). <br /> ❑ Large Quantity Generator with Onsite Treatment(Generates 200 lbs or more/ninth). <br /> Person responsible for implementation of the Medical Waste Managernent Plan: <br /> Name: ��/�6- A)(d All/,EL2 _'Title: /!I/il!/•57'ef'Fi+���' <br /> Phone: t/JD� -11'X5 " c3e--eL -- 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 w. tes": <br /> a) no you genoratc my pharmaceutical waste(expired/outdated.`pent,partials)? <br /> b) CK Yes ❑ No <br /> If yes, describe the type of pharmaceutical waste texpired,spent, partials,outdated, patient <br /> returns,etc): <br /> � �(.�•,�rs��/,�.��t%�-rte _ — <br /> And estimate the monthly tunount of pharmaceutical waste generated at your <br /> facility:��• <br /> HID45-03 5 <br /> !0/2006 <br /> 9T/t7'd 262889t7:01 :14MId T1:2T TT02-2T-Ad14 <br />