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ENVIRONMENTAL HEALTH DEPARTMENT <br /> SAN JOAQUIN COUNTY <br /> 1868 E.Hazelton Avenue <br /> Stockton, California 95205 <br /> Telephone: (209)468-3420 <br /> Fax: (209)468-8392 <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: Trat e� <br /> Business Name: l `� L <br /> 1 P <br /> Business Address: ' ve r( 7 L <br /> r c C,A -7 <br /> City State Zip Code <br /> Phone Number: ( jog ) <br /> Type of Facility or Business: <br /> Cd(1 <br /> REGISTRATION--FOR:-- <br /> F] <br /> EGISTRATI =EOR:❑ 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: L4ara t'f 2. Title: 4;1'6 1 If, M61011'strzIcur <br /> Phone: 9,o— Date: q— t' I <br /> 1. List the types of medical waste generated at your facility(i.e. laboratory wastes,blood or body <br /> fluids, sharps,contaminated animals,sur ical specimens,trace chemo or isolation wastes): <br /> ce t,& 1p livle sdim 2e- ak- <br /> a la" m e . <br /> a)Do you generate Apy pharmaceutical waste(expired, spent,partials,patient returns)? Eirlyes ❑No <br /> If yes, describe the type of pharmaceutical waste(expired, spent,partials,patient returns): <br /> medvc6on vials <br /> And estimate the monthly amount of pharmaceutical waste generated at your facility: ` •a <br /> EHD 45-03 5 <br /> 2015 <br />