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{ <br /> Phone: ( 1 q `" �� -0 1 <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: UA�11A 1) <br /> City State Zip Code <br /> Phone: ('601 ) e13 4 — / <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 /> keeping of all medical waste,including pharmaceutical waste,at your facility: <br /> AJ,e-W 90,71 /a L <br /> j. Describe your medical waste emergency action plan, including procedures for <br /> handling spills, exposures, equipment failures, etc: <br /> e <br /> vg <br /> 6) taate' <br /> P/r (o f CY <br /> M S <br /> I hereby certify to the best of my knowledge and belief that the statements made herein are <br /> correct and true. <br /> Signature: AJ <br /> / <br /> Printed Name: B 1014 <br /> Title: 5c <br /> Date: / <br /> EHD 45-03 7 <br /> 10/6/2006 <br /> r <br />