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ENVIRONMENTAL HEALTH DEPARTMENT <br /> SAN JOAQUIN COUNTY <br /> 1868 E.Hazelton Avenue <br /> Stockton, California 95205 <br /> Telephone: (209)468-3420 <br /> Fax: (209)468-8392 <br /> GUIDELINES FORT E MEDICAL WASTE MANAGEMENT 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 Plan shall contain the following information as appropriate for your <br /> facility: <br /> Business Name: Fop ra/woo c� t�R�4 c�►�� Cava <br /> Business Address: 539L D CX,v r I A .1 C�,r <br /> City State Zip Code <br /> Phone Number: ( 2 01 ) 9-75-300`i <br /> Type of Facility or Business: ®11t u•f5� �c o�� <br /> REGISTRATIO--EOR: <br /> ❑ Small Quantity Generator with Onsite Treatment(Generates less than 200 lbs/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 /> Person responsible for implementation of the Medical Waste Management Plan: <br /> Name: •3 0h Title: vw i w® re�-� ✓" <br /> Phone- .20!1-'1`13-- Q '-I 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 wastes): <br /> E51001A 441 o r 60 W ® u;dl3 t slkorps <br /> a)Do you generate�!py pharmaceutical waste(expired, spent,partials,patient returns)? M Yes ❑No <br /> If yes,describe the type of pharmaceutical waste(expired, spent,partials,patient returns): <br /> AIN ofr Ai,,r . cQ o4c. <br /> And estimate the monthly amount of pharmaceutical waste generated at your facility: 1S <br /> EHD 45-03 5 <br /> 2015 <br />