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. . • i <br /> 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 /> Name: <br /> Address: <br /> City State Zip Code <br /> Phone: ( ) <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: Yes ❑No <br /> i. Describe training provided to staff regarding handling, storage,disposal, and record <br /> keeping of all medical waste,including pharmaceutical waste, at your facility: <br /> e— G7 2r,u o f 5 <br /> e <br /> -0 L4 r <br /> j. Describe your medical waste emergency action plan, including procedures for <br /> handling spills, exposures, equipment failures, etc: t v 5.mac <br /> A-- n LA I <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 Name: Vj <br /> Title: Jv c;k-v e Deli, S vx V <br /> Date: 4k f t o <br /> EHD 45-03 7 <br /> inicnnnc <br />