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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: wvwd Wlam, *-f( <br /> Business Address: <br /> 21 <br /> City State Zip Code <br /> Phone Number: ( ) <br /> Type of Facility or Business: rilm '.rS!n4 Ac131 <br /> REGISTRATION FOR: <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: Title: ;ni <br /> Phone: 'L(73-3oD Date: / a//(& <br /> 1. List the types of medical waste generated at your facility (i.e. laboratory wastes, blood or body <br /> fluids, harps, contamiliated animals, surgical specirpens, trace chemo or isolation wastes): <br /> a) Do you generate aM pharmaceutical waste (expired, spent, partials, patient returns)? Yes ❑No <br /> If yes, des c ibe thet e of pharmaceutical waste (expired, spent,partials, patient returns): <br /> A VC. <br /> And estimate the monthly amount of pharmaceutical waste generated at your facility: <br /> EHD 45-03 5 <br /> 2015 <br />