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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: 5cvv--t <br /> Address: <br /> City State Zip Code <br /> Phone: ( ) <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 /> L Describe training provided to staff regarding handling, storage,disposal,and record <br /> keeping of all medical waste,including pharmaceutical waste,at your facility: t <br /> 1 wyaaa. �..• � ��f St t kc.��t .".�Y Mn W a,�T'.L a• <br /> tr• e <br /> R .ice Q'tac e - o!r' f oK 4�,nt_ <br /> • �1 e <br /> j. Describe your medical waste emergency action plan, includin procedures for <br /> handling spills,exposures,equipment failures,etc: On w— <br /> I hereby certify to the best of my knowledge and belief that the statements made herein are <br /> correct and true. <br /> g <br /> Signature: <br /> Printed Name: J®&4 M C(00- <br /> Title:- ".-t k'& �-p✓' <br /> Date: <br /> EHD 45-03 7 <br /> 10/6/2006 <br />