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e- 1 <br /> — ' ' I ENVIROr*4ENTAL HEALT IWEPARTMENT <br /> 0,Ck"!1y. , SAN JOAQUIN COUNTY Unit Supervisors <br /> Donna K.Heran,R.E.H.S. 600 East Main Street Carl Borgman,R.E.H.S. <br /> Director <br /> Mike Huggins,R.E.H.S.,R.D.I. <br /> U% X Laurie A.Cotulla,R.E.H.S. Stockton, California 95202 <br /> Margaret Lagorio,R.E.H.S. <br /> Assistant Director Telephone: (209) 468-3420 Robert McCleflon,R.E.H.S. <br /> Fax: (209) 468-3433 Jeff Carruesco,R.E.H.S. <br /> Kasey Foley,R.E.H.S. <br /> INFORMATION PACKET FOR MEDICAL WASTE GENERATORS <br /> This packet contains the information and forms you will need to help you comply wit fWCEIVED <br /> Medical Waste Management Act. APR 13 2012 <br /> Instructions OMRONMENTAL HEALTH <br /> PERMMSERVICES <br /> Please return the completed forms prior to medical waste generation or treatment. <br /> 1. Complete the "Pre-Application Questionnaire" on Page 2. If your answers indicate <br /> you are not required to register as a medical waste generator,then complete the <br /> "Certification Statement" on Page 3 and return both complete forms to the mailing <br /> address below. <br /> 2. If you are required to register as a medical waste generator, as indicated by affirmative <br /> answers to questions 3 & 4 on the "Pre-Application Questionnaire", then: <br /> a. Complete the "Registration for Medical Waste" form located on <br /> Page 4. <br /> b. Complete a"Medical Waste Management Plan" following the guidelines <br /> provided on Page 5. <br /> c. Return the completed forms and management plan to the mailing address <br /> below. <br /> Your cooperation in promptly registering and following the specified handling requirements is <br /> greatly appreciated. <br /> If you have any questions regarding registration or handling requirements, please contact(209) <br /> 468-3420 and ask for the Medical Waste Program. <br /> RETURN ALL COMPLETED FORMS TO: <br /> Attn: Medical Waste Program <br /> San Joaquin County Environmental Health Department <br /> 600 East Main Street <br /> Stockton, CA 95202 <br /> EHD 45-03 WEB <br />