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GUIDELINES FOR THE MEDICAL WASTE MANAGEMENT PLAN <br /> (Please Type or Print) <br /> Small quantity generators that provide onsite treatment and all large quantity generators <br /> shall have a medical waste management plan on file with the local enforcement agency <br /> (PHS-EHD). The medical waste management plan shall contain the following information, <br /> as appropriate for your facility: y <br /> Business Name: ./Y,�l <br /> Business Address: ��v2 Y�// <br /> Business Phone: ;-5 _r <br /> Type Of Facility Or Business: <br /> Registered As: (Check One) <br /> (tom Small Quantity Generator With Onsite Treatment. (Generates < 200 lbs./mo.) <br /> ( ) Large Quantity Generator. (Generates 200 lbs. or more/mo.) <br /> ( ) Large Quantity Generator With Onsite Treatment. (Generates 200 lbs.or more/mo.) <br /> Person Responsible For Implementation Of The Plan: <br /> / � <br /> Name: ��` n <br /> �L <br /> Title: Phone: �') ��/ <br /> ATTACH ADDITIONAL INFORMATION <br /> 1. List the types of medical waste generated at your facility, i.e., Laboratory Wastes, <br /> Blood or Body Fluids, Sharps, Contaminated Animals, Surgical Specimens, or <br /> Isolation Wastes. (See "Regulated Medical Wastes" on Page 3.) <br /> 2. Estimat the onthl unt of dical waste generated at your facility. <br /> 3. Describe the me al waste handling procedures utilized by and applicable to your <br /> facility: 4- L -*'� O <br /> a. Onsite location and method or segregatio , containment, packaging, <br /> labelling, and collection. <br /> -CONTINUED ONREVERSE- <br /> 7 <br />