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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: 041\/F_ IT--/ OE '� i1f1r— <br /> Business Address: hAG I F I C- AVt-:�- <br /> STor-KTol�l Gam- .9szl � <br /> City State Zip Code <br /> Q`GPhone Number: ( ) - ' —[(o4S <br /> Type of Facility or Business: <br /> REGISTRATION FOR: <br /> ❑ Small Quantity Generator with Onsite Treatment(Generates less than 200lbs/month). <br /> M 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: kLIAN C"EW5 Title: A( TT nll�t�rl <br /> Phone:UA� `�(#`� Date: <br /> •1-?.011 <br /> 1. List the types of medical waste generated at your facility, i.e., laboratory wastes,blood or body <br /> fluids, sh s, contaminated animals,surgical specimens,trace chemo or isolation wastes": <br /> IW 05 !A TA,MIL41&� I MAS <br /> a) Do u generate pharmaceutical waste(expired/outdated,spent,partials,)? <br /> b) KYMes ❑No <br /> If yes,describe the type of pharmaceutical waste(expired, spent,partials,outdated,patient <br /> returns, etc): <br /> And estimate the monthly ajnount of pharmaceutical waste generated at your <br /> facility: 'L (b5 Yy�anlT}i <br /> EHD 45-03 5 <br /> 10/6/2006 <br />