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09/06/2012 14:49 209473 9 BUSNINESSOFFIC PAGE 04/06 <br /> 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 Management plan on file with the San Joaquin County <br /> Environmental Health Department. The Medical Waste Management flan shall contain, the <br /> following information as appropriate for your facility: <br /> Business Name: <br /> Business Address: j- ';;L� <br /> cz ) <br /> City State Zip Code <br /> Phone Number: ( 3 <br /> Type of of Facility or Business r_t L c,�D --«��'�•�� ��r� <br /> REGISTRATION FOR: <br /> Small Quantity Generator with Onsite"Treatment(Generates less than 200lbs/month). <br /> Large Quantity Generator Only(Generates 200 lbs or more/month). <br /> ❑ Large Quantity Generator with Onsite Treatment(Generates 200 lbs or more/month). <br /> Pearson responsible for implementation-of the Medical Waste Management Plan: <br /> Name: t � �� G '�'7'r�Title: D�(A'215? ?� <br /> Phone: �_ 3ehn Date: r '� <br /> 1. List the types of medical waste generated at your facility,i.e., laboratory wastes,blood or body <br /> fluids s11 s,cont d animals,sur ical specimens,trace chemo or iso/ 'on/was <br /> tes <br /> a) o ou generate pharmtacentical waste(expired/outdated,spent,partials,)? <br /> b) A �yes ❑No <br /> If yes,describe the type of pharmaceutical waste(expired,spent,partials,outdated,patient <br /> retu s,,etc): �� n Ag� t <br /> 11 <br /> And estimate th moat y/amount of pharmaceutical,waste generated at your <br /> facility: <br /> F-RD 45-03 S <br /> Received Timex'Sep, 6. 2012 2: 45PM No. 0247 <br />