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t <br />SANsJOAQUIN Environmental Health Department <br />COUNTY <br />Small quantity generators that provide onsite treatment and all large quantity generators shall have a <br />Medical Waste Management plan on file with the San Joaquin County Environmental Health <br />Department. The Medical Waste Management Plan shall contain the following information as <br />appropriate for your facility: <br />Business Name: <br />Business Address <br />®I V'tve'ka <br />4 "S S <br />r <br />+V vk 7 Y-2-07 <br />City State Zip Code <br />Phone Number: (24 4'17 12 G "I <br />Contact Person: (2 fes+- &rru.'ej <br />Type of Facility or Business: S k.`ct /) µfl � k <br />Registration for: <br />❑ Small Quantity Generator with Onsite Treatment (Generates less than 200 lbs/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 i6^r <br />plementation of the Medical Waste Management Plan: <br />Name: 611PA. ` ell es) Title: 4AA, `%A eS i i - <br />Phone: ,o I - --71 — eZG of 7 Date: 3-( (Q - Zo <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 />Do you generate any pharmaceutical waste (expired, spent, partials, patient returns)? 5Kes ❑ No <br />60f 11 <br />