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0 9 <br /> GUIDELINES 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 <br /> medical waste management plan on file with the local enforcement agency. Minimum required <br /> information: <br /> Business Name: Renal Advantage Inc. <br /> Business Address: 3115 March Lane, Stockton,CA <br /> Business Phone: (209)955-7527 <br /> Type of Facility: Hemodialysis Center <br /> Registered As: (Check One) <br /> ( ) Small Quantity Generator With Onsite Treatment(Generates<200 lbs/mo.) <br /> (X) Large Quantity Generator: (Generates 200 lbs. or more/mo.) <br /> ( ) Common Storage Generator With Onsite Treatment.(Generates 200 lbs. or more/mo.) <br /> ( ) Common Storage Facility(Small Quantity Generators only) <br /> Person Responsible for Implementation of the Plan: <br /> Name: Thaddeus Seals,MSW Title:Center Director Phone:(209)955-7527 <br /> ATTACH THE FOLLOWING ADDITIONAL INFORMATION <br /> 1. List the types of regulated medical waste generated at your facility(include pharmaceutical <br /> waste.) <br /> 2. Estimate the monthly amount of each waste stream in pounds,of medical waste generated at your <br /> 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, labeling <br /> and collection. <br /> b. Storage area description with storage methods utilized, including duration and <br /> temperature controls, if applicable. <br /> C. Onsite treatment facility description, including type of treatment utilized, <br /> maximum capacity time and temperature necessary,alternate contingency plan <br /> in case of equipment failure,etc. <br /> d. Name,address,registration number and phone number of the registered <br /> hazardous waste hauler employed by your facility. <br /> e. Name,address and phone number of offsite treatment facility where medical <br /> waste is transported for treatment, if different than the hauler. <br /> f. Do you have a Limited Quantity Hauling Exemption? Who on your staff is <br /> authorized to transport your medical waste? <br /> g. Do you have tracking documents for all medical wastes handled at your facility? <br /> All medical waste generators are required to keep accurate records regarding <br /> containment,storage,hauling treatment and disposal. All medical waste records <br /> are to be maintained and available for 3 years. <br /> h. Describe your medical waste emergency action plan, including procedures for <br /> handling spills,exposures,equipment failures,etc. <br /> I hereby certifythat to th best of my knowledge and belief that the statements made herein are correct and <br /> true. <br /> SIGNATURE: j TITLE: v► �, irP�c�r® DATE: — 22 - r <br />