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® 0 <br /> Phone: 1 <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: <br /> Address: <br /> City State Zip Code <br /> Phone: l <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 /> keepin of all medical was e,includi g pharmaceutical waste at your facility. <br /> �v- <br /> j. Describe your medical waste emergency action plan, including procedures for <br /> handl' g spills, exposures, equipmen failures,etc: <br /> Ot <br /> I hereby certify to the best of my knowledge and belief that the statements made herein are <br /> correct and true. <br /> Signature: <br /> Printed Name: <br /> Title: n_ <br /> Date: ` \ 1 <br /> EHD 45-03 7 <br /> 10/6/2006 <br />