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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: <br /> Business Address: '5 —S <br /> ram 1 <br /> City IState Zip Code <br /> Phone Number: r- Q t <br /> Type of Facility or Business: 'S�-f�� `� a('5t t,") <br /> REGISTRATION FOR: <br /> ❑ Small Quantity Generator with Onsite Treatment(Generates less than 200lbs/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 ManagementPlan: <br /> Name: �i(��1 �t? /s�C Title: �i/rts�f4ar <br /> Phone: � �' � '� Date: f V1 <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 /> E <br /> a) Do you generate M pharmaceutical waste(expired/outdated, spent,partials,)? <br /> b) 01yes ❑No <br /> If yes,describe the type of pharmaceutical waste(expired,spent,partials,outdated,patient <br /> returns,etc): <br /> And estimate the monthly amount of pharmaceutical waste generated at your <br /> facility: f <br /> K <�(1 G✓I i�� P,,co rw 3 m_d( l I/l eke S.} 21,, Gly <br /> Awa &,?", <br /> EHD 45-03 5 <br /> 10/6/2006 <br />