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Phone: _ <br /> g. Name,address and phone number of Offsite Treatment Facility where pharmaceutical <br /> waste is transported for treat ent, if different than pharmaceutical waste hauler: <br /> Name: 1 M►r k:�jq .- <br /> Address: <br /> f� <br /> City Stat Zip Code <br /> Phone: 1 --7 <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:XYes Q No <br /> L Describe training provided to staff regarding handling,storage,disposal,and record <br /> keeping of all medical waste,including pharmaceutical waste,at your facility: <br /> r <br /> to e <br /> IF <br /> t _rlra <br /> C <br /> j. Describe your medical waste emergency action plan, including procedures for <br /> handling spills,exposures,equipment failures, etc: <br /> 9 <br /> :S► 1�^t <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 <br /> i n u <br /> gat re. <br /> Printed Name:_ t tk- - tN n <br /> Title: �- <br /> Date: I I r ' <br /> f <br /> MID 45-03 7 <br /> Ift/20as <br />