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GUIDELINES FOR THE MEDICAL WASTE MANAGEMENT <br /> PLAN <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 /> Business Name: <br /> Business Address:__ f!/ I <br /> o <br /> City State Zip Code <br /> Phone Number: <br /> Type of Facility or Business: !� <br /> REGISTRATION FOR: <br /> ❑ Small Quantity Generator with Onsite Treatment(Generates less than 2001bs/month). <br /> Large Quantity Generator Only(Generates 200 lbs or more/month). <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: ( Title: <br /> Phone: y — 37/ — 0-700 Date: ! f <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 specimens,trace chemo or isolation wastes": <br /> lrr� yr / <br /> 5 <br /> a) Do you generate a_y pharmaceutical waste(expired/outdated,spent,partials,)? <br /> b) 2 Yes ❑No <br /> If yes,describe the type of pharmaceutical waste(expired,spent,partials,outdated,patient <br /> returns,etc): <br /> , )( /� �i' S <br /> And estimate the monthly amount of pharmaceutical waste generated at your <br /> facility: L4 C.0-41 S <br /> EHD 45-03 5 <br /> 10/6/2006 <br />