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0 <br /> 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: i [..iJ:n <br /> Address: 9 o QZ,- <br /> ! I 100 <br /> ®r-� i <br /> City State Zip Code <br /> Phone: ( got ) cilp - 1555 <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: 9 Yes ❑No <br /> i. Describe training provided to staff regarding handling, storage,disposal, and record <br /> ke9ping of all medical waste,inclu i pharmaceutical waste,at your facility: <br /> CPA i <br /> j. Describe your medical waste emergency action plan, including procedures for <br /> handling spills, exposures, equipment failures, etc: ca <br /> u4n"� V-�� - <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: C{1I V V cc es <br /> Title: Ds p <br /> Date: <br /> EHD 45-03 7 <br /> 10/6/2006 <br />