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3 <br />Phone: ( ) -r � el Le. <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 />le, 146 <br />Address: 01 1 s <br />r , G f <br />Xz 4r <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 rea to <br />be maintained and available for review during inspection for three (3) years. you <br />have tracking documents for all medical wastes handled at your facility: es ❑ No <br />i. Describe training provided to staff regarding handling, storage, disposal, and record <br />keeping of all medical waste, including ph rmaceutt3cal w te, at your facility: <br />j. Describe your medical waste emergency action plan, including procedures for <br />handling spills, exposures, equipment failures, et/cc: <br />S'L .f 't f, -i ems. , `c-«-� <br />�.. i .Ic"wk. is <br />I hereby certify to the best of my knowledge and at the statements made herein are <br />correct and true. <br />Signature: <br />Printed Name: Z h ® <br />Title: <br />Date: <br />EHD 45-03 7 <br />10/6/2006 <br />