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b. Storage area description with storage methods utilized,including duration and temperature <br /> controls, if applicable: � % y <br /> lo3e+ Ke A a+ 4-emo. Was 1 ccll <br /> Ace- a Week <br /> c. Onsite treatment facility description, including type of treatment utilized, maximum capacity, <br /> time and'm erature 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 /> Name: +C rIC ICA <br /> f— CrtC- <br /> Address: JkV1+�\ A- <br /> City State Zip Code <br /> Phone: (3,z 3 ) - n <br /> Registration#: P/00 <br /> e. Name, address and phone number of Offsite Treatment Facility where medical waste is <br /> transported for treatment, if different than hauler: <br /> Name: S "r, VV I <br /> Address: 1-1 IM W. 5WAk- Ave <br /> i-nese o CA. 937 <br /> City State Zip Code <br /> Phone: ( , ) I U -7 -f.4 Z <br /> f. Do you have a Limited Quantity Hauling Exemption: ❑ Yes 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. f <br /> 2 <br /> 3. <br /> h. All medical waste generators are required to keep accurate records regarding containment, <br /> storage, hauling, treatment and disposal. All medical waste records area to be maintained and <br /> available for review during inspection for three(3)years. Do you have tracking documents for <br /> all medical wastes handled at your facility: N Yes❑No <br /> i. Describe your medical waste emergency actionplan, including procedures for handling spills, <br /> exposures, equipment failures, etc: C de'k Ole <br /> I hereby certif to the best of my knowledge and belief that the statements made herein are correct and true. <br /> Signature: Title: C- er TVW-t' Date: —IG- <br /> 06 <br /> EHD 45-02-003 Page 6 of 7 <br /> 10/6/2003 <br />