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SA N X10 A Q U I N Environmental Health Department -- C O U N T Y----- Phone: ( ) Registration#: h. Do you handle pharmaceutical waste that is classified by the federal Drug Enforcement Agency (DEA) as "controlled substances"? ❑Yes 2'No If yes, describe how the"controlled substances" are disposed: i. All medical waste generators are required to keep accurate records regarding containment, storage, hauling, treatment and disposal. All medical waste records are to be maintained and available for review during i pection for two(2)years. Do you have tracking documents for all medical wastes handled at your facility? ❑ No j. Describe training provided to staff regarding handling, storage, disposal, and record keeping of all medical waste, including pharmaceutical waste, at your facility: 54—c lir;, — f7n l�� Svst+, +•_�►�/Gtw•.c n.cw3 /1.h k. Describe your medical waste emergency action plan, including procedures for handling spills, exposures, equipment failures, etc. (attach information as necessary): StAk 1. Describe how reusable medical waste carts or containers are cleaned and decontaminated (see below for approved cleaning methods): Approved cleaning methods include agitation to remove visible soil combined with one of the following: 1. Exposure to hot water of at least 82 degrees Centigrade(180 degrees Fahrenheit)for a minimum of 15 seconds. 2. Exposure to chemical sanitizer by rinsing with, or immersion in, one of the following for a minimum of three minutes: • Hypochlorite solution(500 ppm available chlorine) • Phenolic solution(500 ppm active agent) • Iodoform solution(100 ppm available iodine) • Quaternary ammonium solution(400 ppm active agent) m. Describe, if medical waste is treated onsite, a closure plan for the termination of treatment, using at a minimum, one of the above referenced approved cleaning methods: 1 hereby certify to the best of my knowledge and belief that the statements made herein are correct and true. Printed Name: Ty q% - Signature: Title: 1� Date: 7i 7 d 7of8