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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 /> { -� r V► <br /> Name: y <br /> Address: —OLD rJ- 11yG W <br /> 5cit+ Ut,L-O-. lir O;q <br /> City State Zip Code <br /> Phone: ( lo)_ - S 1 k-0 <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. o you <br /> have tracking documents for all medical wastes handled at your facility: Wes❑No <br /> L Describe training provided to staff regarding handling,storage,disposal,and record <br /> keee ing of all medif�a_l waste,including harma euti 1 waste,at your facility: <br /> j. Describe your medical waste emergency action plan, including procedures for <br /> handling spills,/exposures, equipment failures,etc: 1 <br /> ��1�✓1R.� �(.2..� �� --2rPJ� ply Vt U f.J� <br /> I hereby certify to the best of my knowledge and belief that the statements made herein are <br /> correct and true. <br /> Signature- 1 <br /> Printed Name:'. o ►'� ���� tai" <br /> Title: '�Tw IV y fi Art& N �,�t�!- S Qi✓�lt Lig--1 <br /> Date: <br /> EHD 45-03 7 <br /> 10/6/2006 <br />