Laserfiche WebLink
GUIDELINES <br /> FOR THE MEDICAL WASTE MANAGEMENT PLAN <br /> (Please Type or Print) <br /> Small quantity generators that provide onsite treatment and all large quantity generators shall have a medical waste <br /> management plan on file with the local enforcement agency. Minimum required information: <br /> Business Name: ue ;4- -DtQ i�IOS-icS Glens Q1 �b✓ ar Szm ad <br /> Business Address: 7-2-`l 1 rC I- <br /> Business Phone: (101 ,951 - 5,2 <br /> Type Of Facility/Business: C. i Lobo <br /> Registered As: (Check One) <br /> ( ) Small Quantity Generator With Onsite Treatment. (Generates<200 IbsJmo.) <br /> ( Large Quantity Generator. (Generates 200 lbs. or more/mo.) <br /> ( ) Large Quantity Generator With Onsite Treatment. (Generates 200 lbs. or more/mo.) <br /> ( ) Common Storage Facility(Small Quantity Generators only.) <br /> Person Resonsible For Implementation Of The Plan: << h"�r C��l_5g3 <br /> V ^+' . Title: 5CW eY'Y 150 Y� Phone: <br /> Name: <br /> �tl o ATTACH THE FOLLOWING ADDITIONAL INFORMATION <br /> 1. List the types of regulated medical waste generated at your facility(refer to list on page 2). <br /> 2. Estimate the monthly amount, in pounds,of medical waste generated at your facility. <br /> 3. Describe the medical waste handling procedures utilized by and applicable to your facility: <br /> a. Onsite location and method for segregation,containment, packaging, labelling, and collection. <br /> b. Storage area description with storage methods utilized, including duration and temperature <br /> controls, if applicable. <br /> c. Onsite treatment facility description, including type of treatment utilized,maximum capacity, time <br /> and temperature necessary, alternate contingency plan in case of equipment failure, etc. <br /> d. Name, address, registration number, and phone number, of the registered hazardous waste hauler <br /> employed by your facility. <br /> e. Name, address, and phone number of offsite treatment facility where medical waste is transported <br /> for treatment,if different than the hauler. <br /> f. Do you have a Limited Quantity Hauling Exemption? Who on your staff is authorized to transport <br /> your medical waste? <br /> or Do you have tracking documents for all medical wastes handled at your facility? All medical <br /> waste generators are required to keep accurate records regarding containment, storage, hauling, <br /> e records are to be maintained and available for 3 years. <br /> treatment and disposal. All medical wast <br /> h. Describe your medical waste emergency action plan, including procedures for handling spills, <br /> exposures,equipment failures,etc. <br /> I hereby certify that to the best of my knowledge and belief that the statements made herein are correct and true. <br /> a TITLE: YVI , DATE: l co <br /> SIGNATURE: <br /> 67 <br /> 5 <br />