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Phone: <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: buy Gt,c^I ale-. <br /> Address: <br /> C*-- `13722 <br /> City State Zip Code <br /> Phone: (M) IM - -142-2— <br /> h. <br /> $3 - -14LLh. 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. o 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,including pharmaceutical waste,at your facility: <br /> S1• o Q pia" t4TAgGeN TMAy I w W I TIt 5X ( SERC H 5 <br /> T IS -666 t <br /> 412 <br /> rc5 <br /> n)C Z. <br /> ALSO 46*119: ROP12 112ALM I N10- A:I-AgML 4r5- St7 LC-L 'l p <br /> j. Describe your medical waste emergency action plan, including procedures for <br /> handling spills, exposures, equipment failures, etc: IN <br /> (zFIN Th f L*= f�t2�C.Art.T�n�S C�1 /J <br /> I lv LL S <br /> tD <br /> kkW-W lfvS <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: &�.1q,J Ct�-F,020-r <br /> Title: Q S Y- N*NA6*-MVJ T- -MEGA C-W4 <br /> Date:T� <br /> EHD 45-03 7 <br /> 10/6/2006 <br />