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Phone: ( / 2 s `7'(// <br /> C'. Lame, address and phone number of Offsite Treatment Facility where pharmaceutical <br /> waste is transported for treatment, if different than pharmaceutical waste hauler: <br /> Name: �}{�i � <br /> Address: L$t44 t%, r77'7 fl, <br /> City State Zip Code <br /> Phone: ( i3'l) el3� • (z-.�-Z <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: dyes ❑ 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 /> Ct t f rat F N, QLD 1-1 p P- AZT—p E-D. <br /> i <br /> j. Describe your medical waste emergency action plan, including procedures for <br /> handling spills, exposures, equipment failures, etc: S'Pt-"r R 0 R t ES <br /> 7 T-t)VIFI�I� 9F-P� It Y "M LACE T-7 C-t aJ td® �,hY >Fliu 5. <br /> Floose�� P7-P-F E 5 r-fk r >rna e ,t?Au <br /> 1r i PSI k'f?I Ak t-Y 0L; I 4::;,VIAL.i,t. r�o <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: Ir <br /> Title: 6i0f-tt�ICh-I cft A133 <br /> Date: ( t t7 <br /> rtro 45-03 7 <br />