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GUIDELINES FOR THE MEDICAL WASTE MANAGEMENT <br /> AN <br /> Small quantity generators that provide Onsite Treatment and all large quantity generators <br /> shall have a Medical Waste Management plan on file with the San Joaquin County <br /> Environmental Health Department. The Medical Waste Management Plan shall contain the <br /> following information as appropriate for your facility: <br /> Jau I VA DCU-& 4E, <br /> Business Name: ` <br /> Business Address: 1 �A <br /> 47V 5 Lo <br /> City State , ` Zip Code <br /> Phone Number: ! ) <br /> Type of Facility or Business: k (Affif, <br /> REGISTRATION FOR: <br /> ❑ Small Quantity Generator with Onsite Treatment(Generates less than 200lbs/month). <br /> t& Large Quantity Generator Only(Generates 200 lbs or morelmonth). <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:5�U I V-V-) Title: <br /> Phone:2Dq -l t)4 D b c5�—) Date: lU ?Z/I 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,surgical spec' ens,trace chemo or isolation wastes": <br /> n �rru <br /> a) Do you generate my pharmaceutical waste(expired/outdated,spent,partials,)? <br /> b) ❑Yes [9-No <br /> If yes,describe the type of pharmaceutical waste(expired,spent,partials,outdated,patient <br /> returns,etc): <br /> And estimate the monthly amount of pharmaceutical waste generated at your <br /> facility: <br /> EHD 45-03 5 <br /> 10/6/2006 <br />