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r <br />Phone: (5 - � TZ - <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: 1.4 s I e, dwR <br />Address:.S' 5 - <br />Cit' State Zip Code <br />Phone: Q%) 2=61-3D3 <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 />i. Describe training provided to staff regarding handling, storage, disposal, and record <br />keeping of all medical waste, inclining pharmaceujical waste, at yRur facility:` <br />j. Describe your medical waste emergency action plan, including procedures <br />4anglinig spills, exposures, equipment failures, etc: ` ? <br />I hereby certify to the best of my knowledge and belief that the statements made herein are <br />correct and true. <br />Signature: <br />Printed Name: !may <br />Title: 6e' -IJ Mta.".a rL, <br />Date: z -Z () •- z 0 IL <br />EHD 45-03 7 <br />10/6!2006 <br />