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I IN M,,,- no I ztl a I of I IT M'' 'ta No I <br />MEMO I V <br />Fax: (209) 468-8392 <br />Small quantity generators that provide onsite treatment and all large quantity generators shall have a <br />Medical Waste Management plan on file with the San Joaquin County Environmental Health Department. <br />The Medical Waste Management Plan shall contain the following information as appropriate for your <br />facility: <br />Business Name: 4';-rpC1t-Tw 1akc7l)OAL- CAV -6 CariTEle, <br />Business Address: R1 V), au IN 5 <br />6nc M10 C, ft q5aa <br />City State Zip Code <br />Phone Number: w) 71F <br />Type of Facility or Business: -6A Pi <br />REGISTRATION--FOR:,- <br />F] Small Quantity Generator with Onsite Treatment (Generates less than 200 lbs/month). <br />Large Quantity Generator Only (Generates 200 lbs or more/month). <br />❑ Large Quantity Generator with Onsite Treatment (Generates 200 lbs or more/month). <br />Person responsible for implementation of the Medical Waste Management Plan: <br />Name: L4 V%t i6 Title: <br />t on e <br />Phone: UR - M It) Date: <br />1. List the types of medical waste generated at your facility (i.e. laboratory wastes, blood or body <br />fluid , sharps, con t!F'nat5dWni*maI * cal specimens, trace chemo or isolation wastes): <br />11 6 S, n9F., <br />91 An a h n �1'j /111 1; <br />a) Do you generate ggy pharmaceutical waste (expired, spent, partials, patient returns)? F1 Yes DjrNo <br />If yes, describe the type of pharmaceutical waste (expired, spent, partials, patient returns): <br />And estimate the monthly amount of pharmaceutical waste generated at your facility: <br />EHD 45-03 5 <br />2015 <br />