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L9 S '°N AVS01 610 lZ 'unr ;W 10 ni ;) <br /> voJ Environmental Health Department <br /> ---� C U U N TY-- <br /> Phone: ( ) Registration#: <br /> h. Do you handle pharmaceutical waste.that is classified by the federal Drug Enforcement.Agency(DEA)as <br /> "controlled substances"? ®*les[] No <br /> If yes, describe how the"controlled.substances"are disposed: <br /> i. All medical waste generators are required to.keep accurate records regarding cgntainment, storage, hauling, <br /> treatment and disposal. All medical waste records are to be maintained and available for review during <br /> inspection for two(2)years, Do you have tracking documents for all medical wastes handled at your facility?d <br /> Yes® No <br /> j. Describe training provided to staff regarding handling,storage,disposal, and record keeping of all medical <br /> waste, including pharmaceutical waste,at your facility: <br /> Sec k <br /> k. Describe your medical waste emergency action plan, including procedures for handling spills, exposures, <br /> equipment failures, etc. (attach Information as necessary), <br /> -)fm <br /> I. Describe how reusable medical waste carts or containers are cleaned and decontaminated (seabelow for <br /> approved cleaning methods): <br /> Approved cleaning methods include agitation to remove visible soil combined with one of the following: <br /> 1. Exposure to hot water of at least 82 degrees Centigrade(18.d.degrees Fahrenheit)for a minimum of 15 seconds. <br /> 2. Exposure to chemical sanitizar by rinsing with,or immersion in,one of the following for a minimum of three minutes: <br /> • Hypochlorite solution(500 ppm available chlorine) <br /> • Phenolic solution(5Q0 ppm active agent), <br /> • lodoform solution(100 ppm available iodine) <br /> • <br /> Quaternary ammonium solution(400 ppm active agent) <br /> m, Describe, if medical waste is treated onsite,a closure plan for the termination of treatment, using at a minimum, <br /> one of the above referenced approved cleaning methods: <br /> I hereby certify to the best of my knowledge and belief that the stateTw"acjokein are correct and true. <br /> Printed Name; Signature: <br /> Title: IV In! Date. 6-7is !i i <br /> 7 of <br /> i <br />