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Phone: ( ) <br /> g. Name,address and phone number of Offsite Treatment Facility where pharmaceutical <br /> waste is transported for treatment,if different than pharmaceutical waste hauler: <br /> Name: <br /> Address: <br /> City State Zip Code <br /> Phone: ( ) <br /> h. All medical waste generators are required to keep accurate records regarding <br /> containment,storage,hauling,treatment and disposal. All medical waste records area to <br /> be maintained and available for review during inspection for three(3)years. Do you <br /> have tracking documents for all medical wastes handled at your facility: ❑Yes❑No <br /> L Describe training provided to staff regarding handling,storage,disposal,and record <br /> k eping of all medical waste,Jnc uding pharpiaceutical waste at y f i 'ty: <br /> fc.tA'3f/�C Gi O/�l/tG�F// �.fi Ctyrt <br /> j. Describe your medical waste emergency action plan, including procedures for <br /> handlin spills, exposures,equipment failures, etc: <br /> I hereby certify the best of Tx knowledge and belief that the statements made herein are <br /> correct an r '. <br /> Signature: <br /> Printed Name: IAA' <br /> 4 �AXAUMWMd 4"Title: <br /> Date: 41ehl <br /> EHD 45-03 7 <br /> 10/6/2006 <br />