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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: yrI / I l <br /> Business Address: lite) • 1e a" <br /> LVni C <br /> City State Zip Code <br /> Phone Number: ( 2 ) <br /> Type of Facility or Business: CTtvxe�r <br /> REGISTRATION FOR: <br /> Small Quantity Generator with Onsite Treatment(Generates less than 200lbs/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: t Title: <br /> Phone: Date: ® I ®I 21 <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 /> c�'AALV7cS P S{A� CL ef,i V®S <br /> a) Doyou generate any pharmaceutical waste(expired/outdated,spent,partials,)? <br /> b) X Yes ❑No <br /> If yes,describe the type of pharmaceutical waste(expired,spent,partials, outdated,patient <br /> returns,etc): <br /> fx�es #y 1 C C G.-Y <br /> And estimate the monthly amount of pharmaceutical waste generated at your <br /> facility: % — Z \ S <br /> EHD 45-03 5 <br /> 10/6/2006 <br />