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ipiC/21/2015/bION 06: 13 Ply FAX No, _ P. 001 <br />jENVIRONMENTAL HEALTH DEPARTMENT <br />SAN UIN COUNTY <br />1868 E. Hazelton Avenue <br />Stockton, California 95205 <br />Telephone: (209) 468-3420 <br />Fax: (209) 468-8392 <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 yaux <br />facility: I j n 1 / _j1_ <br />13usiness Name: <br />Business Address: <br />Phone Number: <br />Type of Facility or Business: <br />❑ Small Quantity Generator with Onsite Treatment (Generates less than 200 lbs/month). <br />n""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 Plau: <br />Name: <br />Phone: c2d Cl " q(V & -O9S-&y Date: <br />/i C'?" / / "5- <br />1. 'List the types of medical waste generated at your facility (i.e. laboratory wastes, blood or body <br />fluids, sharps, contaminated animals, surgical specimens, trace chemo or isolation wastes): <br />Y <br />a) Do you generate ay pharmaceutical waste (expired, spent, partials, patient returns)? 0 Yes ❑ No <br />If yes, describe <br />waste (expired, spent, partials, patient returns): <br />And estimate the monthly amount of pharmaceutical waste generated at your facility: ! � �_I/ <br />EI-? 45-03 S <br />Receiv,d ?ime Dec. 21. 2015 5:19PM No, 1447 <br />