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DaVita Health-& Safety Policies, Procedures & Guidelines <br />DaVita Inc. <br />State Specific Policy -California <br />CALIFORNIA MEDICAL WASTE MANAGEMENT/PHARMACEUTICAL WASTE <br />DOCUMENT -ATTACHMENT A <br />Assignment of Responsibility <br />The California Medical Waste/Pharmaceutical Waste Management Plan Administrator(s) has the authority and responsibility for <br />implementing the provisions of this program in DaVita Dialysis Facilities. <br />IQEAkN Q—A0 ` ��e,�- and/or 1-0 1Z , WA-rL- . / are the administrators for the <br />Facility Management, Print Name Regional Director, Print Name <br />California Waste Management Plan at DAVITA -� <br />Fac ity Name <br />Address City State Telephone # <br />The program administrator(s) is responsible for ensuring exposures to infectious agents are minimized throughout the process of <br />handling and disposing of medical waste/pharmaceutical waste. This includes, but is not limited to, the use of protocols, <br />procedures and training, personal protective equipment, and physical containment. <br />I (we) _� iL-Ar,-s C�p �� rV and/or - i , W pry certify that the information <br />Facility Management, Please Print Regional Director, Please Print <br />within this plan is complete a4d correct. <br />Date Regional Director, Signature <br />Date <br />Estimated Average Monthly Quantities of Medical Waste: 60 ® Pounds Pharmaceutical Waste ( S_ Pounds <br />Collection (Hauler) of Medical Waste/Pharmaceutical Waste <br />1. All DaVita entities will contract with an off-site transportation company that is registered with the State Department of <br />Environmental Regulation! <br />Hauler Company Name:-�. �H <br />X4(0( N <br />Address <br />Hauler's Registration Certificate #: <br />(,Atcrt. ! L_ („ate ti(.� ( j(, 7s 25600 <br />City State Zip Code Telephone # <br />3y0< <br />2. The name, address and telephone number of the medical waste hauler used for each facility will be located in a three ring <br />binder or file folder labeled Medical Waste (see Recordkeeping). <br />Off -Site Treatment/Disposal Location and Method of Treatment/Disposal <br />Treatment Site: r , w c (--, <br />`4 t (3 W . bw 1 Y iui fy �y,�auic � JS w q C Q1 3 1 1. ZL- � T7 <br />. <br />ESS 1 S �tS� ;�R, ths1:ST�' C_ _ qT-6i3 , '3! Cn�'i0`�� <br />Address City State Zip Code Telephone # <br />Treatment Method: Q.-tcz u e., <br />Property of DaVita Inc. <br />Origination Date: May 2006 <br />Revision Date: <br />Page 10 of 10 <br />N <br />Confidential and Copyrighted ©2006 <br />9C �%ob t <br />Noir-T N `Jew i L� e_ C,J i �� t 1 <br />r -- , \ C 12 f_ - /.c_ . rll <br />