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Phone: ( -� <br /> g. Name,address and phone number of Offsite Treatment Facility where pharmaceutical <br /> waste is transported for treatment,if different than pharmaceutical waste hauler: <br /> Name: _ AL-7-r to j3r L_ 'yore c- <br /> Address: Sr-, <br /> City State Zip Code <br /> Phone: 05-161 .2 �P'?// <br /> h. All medical waste generators are required to keep accurate records regarding <br /> containment,storage,hauling,treatment and disposal. All medical waste records area to <br /> be maintained and available for review during inspection for three(3)years. Do you <br /> have tracking documents for all medical wastes handled at your facility: Yes❑No <br /> i. Describe training provided to staff regarding handling, storage,disposal,and record <br /> keeping of all medical waste,including pharmaceutical waste, at your facility: <br /> CIAD <br /> r�-rt c7p► zc�� er �2 `L. <br /> �FAo�nL��,n,�-112 <br /> 1`� r 0 f �4 Y ®C fc2 <br /> -i,_ . U(SSE® <br /> A - S C 1Lf !Z:`4 <br /> j. Describe your medical waste emergency action plan, including procedures for <br /> handling spills, exposures, equipment failures, etc: <br /> 1=-iL ec F-)--o" /R2C-V' S VR5App- <br /> I hereby certify to the best of my knowledge and belief that the statements made herein are <br /> correct and true. <br /> ®c..._.. <br /> Signature: <br /> Printed Name: 6 r 7'-"c- ) <br /> Title: "I 15 hr-® <br /> Date: <br /> EHD 45-03 7 <br /> 10/6/2006 <br />