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EC/21/2015/MON 06:13 PM • FAX No, • P. 001 <br />ENVIRONMENTAL HEALTH DEPARTMENT <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 your <br />facility: 1 1 „ , / J -- <br />Business <br />-- <br />Business Name: <br />Business Address: <br />Phone Number: <br />Type of Facility or Business: <br />City State Zip Code <br />•'*mgri <br />i.r / Mo �� M <br />❑ Small Quantity Generator with Onsite Treatment (Generates less than 200 lbs/month). <br />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 Plan: <br />Name: <br />Phone, --26q`'/(a&-C7gS- P bate: /07 a/ %"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 />r - <br />a) Do you generate =y pharmaceutical waste (expired, spent, partials, patient returns)? Z 'Y'es [l No <br />If yes, describe the type of pharmaceutical waste (expired, spent, partials, patient returns): <br />And estimate the monthly amount of pharmaceutical waste generated at your facility: <br />Hein 45-03 5 <br />Received Time Dec,21, 2015 5:19PM No,1447 <br />