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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 <br />g the provisions of�this program in DaVita Dialysis Facilities. <br />H e_Q+rj`� beaVCytand/or 6W)' <br />WI 6V6LC Cq are the administrators for the <br />Facility Management, Print Name Regional ; Director, Print e <br />California Waste Management Plan at DAVITA - Lodi Na I y S l$ <br />Facility Name <br />Ib(o w .Kn-Ljv am � Rc�D UocC M (wq -qg- 33q-gg)b8 <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 pandd training, personal protective equipment, and physical containment. <br />( <br />I (we) I I J j�aAand/or heir 1 67M (Ck4 certify that the information <br />Facility Management, Please Print Regional Director, Please Pfint <br />11 in 's plan is complete and correct. <br />V <br />L_+& <br />!D d 6 ( <br />� <br />Facility Management, Signature <br />Date <br />Regional Director, Sig a <br />Date <br />Estimated Average Monthly Quantities of Medical Waste: � bb Pounds Pharmaceutical Waste <br />IS -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 Regulations. /I -j � f 1 <br />Hauler Company Name: <br />Address City <br />Hauler's Registration Certificate #: Z) iOc) <br />bOOLf QJ2_ - 3b A-3ob <br />State Zip Code Telephone # <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 Treatme ispoCal Loc ti and Method of Treatment/Disposal <br />Treatment Site: �%vi W c LPi <br />Facility name <br />�0 N: I (00 WC -St w4c f 6 (.LA (NX36 -lS SS� <br />Address f City State Zip Code Telephone # <br />Treatment Method: <br />Property of DaVita Inc. Confidential and Copyrighted ©2006 <br />Origination Date: May 2006 <br />Revision Date: <br />Page 10 of 10 <br />