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i <br /> N ®'1 R J �TNMEN A HEALTH EPAR ANR <br /> SAN JOAQUIN COUNTY <br /> 600 fast Main Street <br /> Stockton. California 95202-3,029 <br /> 1 elephone: (209) 468-3,42o <br /> I ax: (209) 468-3,413, <br /> G'L IDEL(NES FOR THE: MEDICAL WASTE MANAGEMENT PLAN <br /> Small quanticv generators that provide Onsite 1 reatment and all larLe quantity generators shall hale a <br /> Medical \Uste Mana«Lment plan oil file "ith the Stn .loagUin ('01.111t. F: 161-ontnental Health C9cp1r1Itient. <br /> The Medical Taste %lanaiiement Plan shall contain the information as appropriate 1'01- vOur <br /> taeilit�: <br /> 13u;ines \amc: 0 ip4ri Care <br /> I�IIiInc�� �ddt'ess: ! 2, 9 i> <br /> Cit% Zip ode <br /> Phone �umher: 120 9) AW: V�� <br /> — p l <br /> I ype of I acilit\ or Business: <br /> REGISTRATION FOR: <br /> Small Quantit\ Generator�\ith Onsite Treatment((Jenerate., less than 200 lbs month). <br /> ❑ Large Quantity Generator Only (Cienerates 200 lbs or more month). <br /> ❑ Large Quantity GeneraLol- �kith Onsite 1 reatnent(Generates 200 lbs or more-month). <br /> Person responsible for implementation of the Medical Waste Management Plan: <br /> n <br /> n • <br /> e <br /> Name: ' (( / Title: <br /> 1q1_tLA4eh <br /> x <br /> Phone: i 3 3 1 - (®X Date: <br /> I. I__ist the t�pe:,ofinedical ��aste g�enerated at \our facility. i.e.. laborator\ ��astes. blood of body <br /> fluids. shams. contaminated animals. surgical specimens. tichemo or isolation castes' <br /> c <br /> a) Do \ou generate anc pharmaceutical i ante (expired. spent. partials. patient returns)? kYes ❑ No <br /> It yes. describe the type of pharmaceutical waste (expired. spent. partials. patient returns): <br /> end e;tin7ate the ntonthk amount of pharmaceutical waste generated at \01,11taeilitV: � �L>4� <br />