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° • <br /> GUIDELINES FOR THE MEDICAL WASTE MANAGEMENT <br /> PLAN <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 San Joaquin County <br /> Environmental Health Department. The Medical Waste Management Plan shall contain the <br /> following information as appropriate for your facility: <br /> Business Name: <br /> Business Address: <br /> S+0 r <br /> City State Zip Code <br /> Phone Number: <br /> Type of Facility or Business: CrjA1 eV- <br /> 'S <br /> REGISTRATION FOR: <br /> [' Small Quantity Generator with Onsite Treatment(Generates less than 2001bs/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: 00jV-A'4-V-% Title: b1,S <br /> '1 S® A(0 OrS 0 i2 <br /> Phone. ��g� Date: l2 <br /> ( & -- ,),,D <br /> 1. List the types of medical waste generated at your facility, i.e., laboratory wastes,blood or body <br /> fluids, sharps, contaminated animals, surgical specimens,trace chemo or isolation wastes';: <br /> S►k-%- 5 ceb vA S o 'r c S <br /> a) Do you generate aM pharmaceutical waste(expired/outdated, spent, partials,)? <br /> b) $dYes 1 <br /> If yes,describe the type of pharmaceutical waste(expired, spent,partials,outdated,patient <br /> returns,etc): <br /> And estimate the monthly amount of pharmaceutical waste generated at your <br /> facility: 1 — 1_ rw "�• rn t✓"�`cwc`� <br /> iL-'+ <br /> EHD 45-03 5 <br /> i n is i�nnc <br />