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ENVIRONINTAL HEALTH DEPARTMENT <br /> SAN JOAQUIN COUNTY <br /> 304 East Weber Avenue, Third Floor <br /> Stockton, California 95202 <br /> Telephone: (209) 468-3420 <br /> Fax: (209)468-3433 <br /> GUIDELINES FOR THE MEDICAL WASTE MANAGEMENT PLAN <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: <br /> Business Name: t ca c LL I un.-e_ <br /> Business Address: , S !, 4+ <br /> S c� <br /> City State Zip Code <br /> Phone Number: ( ) QW—s-iV. <br /> Type of Facility or Business: U16V1 c- <br /> REGISTRATION FOR: <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: a Vr" f,121; Title: 1 y c o �r Vri ,,- <br /> Phone: y C40 d S 13(. Date: u I -' o <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 /> a)Do you generate M pharmaceutical waste(expired, spent,partials, outdated)? ❑ Yes ❑ No <br /> EHD 45-03 Page 1 <br /> 6/8/05 <br />