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0 <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 utiliz ,maximum capacity, <br /> time and temperature necessary, alternate contingencplan i case equipment failure,etc: <br /> d. Name, address,registration number and pho u r o e registered hazardous waste hauler <br /> employed by your facility: JIN <br /> Name: <br /> Address: <br /> N I—) <br /> City \J State Zip Code <br /> Phone: r <br /> Registration <br /> e.Name, address and phone numbs �fsite Treatment Facility where medical waste is <br /> /?b, <br /> transported for treat nt, if 'iffere than hauler: <br /> Nam <br /> s. <br /> Address: <br /> t� <br /> Phone: AD <br /> I State Zip Code <br /> / <br /> I <br /> f. Do you have a Limitectlouantity Hauling Exemption: []Yes E]No <br /> g. Who on your staff'is/ authorized to transport your medical waste? (If more than 3 names, <br /> attach a list): <br /> List Names: /1. <br /> 2. <br /> 3. <br /> h.All me 'cal waste generators are required to keep accurate records regarding containment, <br /> stojr�a ,hauling,treatment and disposal.All medical waste records area to be maintained and <br /> av ' le for review during inspection for three(3)years.Do'you have tracking documents for <br /> all medical wastes handled at your facility: [:]Yes[]No <br /> i. Describe your medical waste emergency action plan, including procedures for handling spills, <br /> exposures, equipment failures, etc: <br /> I hereby certify to the best of my knowledge and belief that the statements made herein are correct and true. <br /> Signature: Title: Center Director Date: <br /> EHD 45-02-003 Page 6 of 7 <br /> 10/612003 <br />