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Phone: ( wl ?J3 L 5 l <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: S 1 d & F nv <br />Address: <br />C✓(T <br />Ci _ State Zip Code <br />Phone: ( I I XQ <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. Do you <br />have tracking documents for all medical wastes handled at your facility: [Z Yes ❑ No <br />L Describe training provided to staff regarding handling, storage, disposal, and record <br />keeping of all medical waste, including pharmaceutical waste, at your facility: <br />j. Describe your medical waste emergency action plan, including procedures for <br />handling spills, exposures, equipment failures, etc: <br />I hereby certify to the best of my knowle and belief that the statements made herein are <br />correct and true. <br />Signature: f--� <br />Printed Name: 3-6 b r, ►1j1 -ell <br />Title: Se. P)1 a,r S Vc' <br />Date: i �- 1 a-3 (V4 <br />EMD 45-03 7 <br />10/6/2006 <br />