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APR-06-11 10:33 FROM- 0 0 T-853 P.04/13 F-873 <br /> GUIDELINES FOR THE MEDICAL WASTE MANAGEMENT <br /> PLAN <br /> Small quantity generators that provide Onsite Treatment and all large quantity generators <br /> shall have a Medical Waste Management plan on file with the San Joaquin County <br /> Environmental Health Department. The Medical waste Management Plan shall contain the <br /> following information as appropriate for your facility: <br /> Business Name: �V4 <br /> 2 tf� <br /> Business Address � 1A^J /- <br /> 112,4 C e <br /> City State Zip Cole <br /> Phone Number: °?� 3 a <br /> Type of Facility or Business: <br /> REGISTRATION FOR.: <br /> [] mallQuantity Generator with Onsite Treatment(Generates less than 200lbs/month)_ <br /> Large Quantity Generator Only(Generates 200 lbs or more/month). <br /> E] 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: A 15 Title:/ 2_ee(m <br /> Phone- Date0? � - 6-- : 1 <br /> 1. List the types of medical waste generated at your facility,i.e.,laboratory wastes,blood or'body <br /> Elul harps,contaminate als,surgi al imeWjxw chemo isolation w <br /> IT f <br /> e Llo c <br /> a) Do y generate any pharmaceu ' 1 waste(expired/outdated,spent,partials,)? <br /> b) es ❑No <br /> If yes,describe the type of pharmaceutical waste(expired,spent,partials,outdated,patient <br /> returns,etc): n _ . <br /> And estimate the mo thly amount of pharmaceutical waste generated at your <br /> facility: /d <br /> EHD 45-03 5 <br /> 1as/2o06 <br />