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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: S-tc'l-1C44 <br /> Address: qe e"--UA 1100 V!l✓a-r <br /> `n.-1-4 unu—I Etc <br /> City _ State Zip Code <br /> Phone: ( '601 ) '1,-(0 — i-i'f� <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,including pharmaceutical waste,.at your facility: <br /> fit`r CwrAd'�as.e { :a�a�uag r�w�?.i<aYr 5�t9�—t••a —t9Ual..sar,Y�j FZYL ALY— <br /> iYiG S•�r�f=i~ A� v+i'FLL. A5 YWae.!"tt-AYA1 h _5(aF'C'i� w7,r.a»s Gu W C,t!'Vy�"'k)"7S <br /> j. Describe your medical waste emergency action plan, including procedures for <br /> handling spills, exposures, equipment failures, etc: SVKAYIr " j 1')% <br /> MQV-IOLE b'P V, eeArA a VU-n- e-I S PAfe:vl A%tit -M <br /> Ci.Cn..i hw�' SV'1 ti.�_ S'fo.�i"� "Sl--lh'7 ia`2L= k k'd'GC��7 /sYLF iN;"Yt2Al C°'"P Y�� <br /> �G 3e, 5�=�.3.ef ch/Ynnt� �—r�l.`--` �''t tJ' S'- N'r'•aVtitilWL'tLl�g �{2 <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: <br /> Title: �='acyl,;•;�� .`C�e�>Jl�,� Sv���vtlr� <br /> Date: <br /> EHD 45-03 7 <br /> 10/6/2006 <br />