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•1®/14/;CE71;i lti:l� "La:7'L.iy4 ��wr►i�wacc�n rE-e� ats <br /> Phone: .. <br /> g. Name,addresms and phone number of Offsite Treatment Facility where phargaaceutical <br /> waste is transported for treatment,If different than pharmaceutical waste hauler: <br /> Name: b�GC K-2 fit... "-4_ <br /> Address: <br /> city State Zip Code <br /> Phone: i <br /> h.- All medical waste generators arc 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. o you <br /> have tracking documents for all medical wastes handled at your facility: plyes❑No <br /> i. Describe training provided to staff regarding handling,storage,disposal,and record <br /> keeping of all medical waste,including pbaliccutical was ,at your facility. <br /> c oma` P t�- <br /> g, b <br /> j. Describe your medical waste emergency action plan, including procedures for <br /> handling spills,exposures,equipment failures,etc: <br /> �Z-L <br /> ,® a��. <br /> I hereby certify to the best of my knowledge and belief that the statements made herein are <br /> correct and true, <br /> Signature: <br /> Printed Name: f a,44--t <br /> Tide: L4 (-�►�` <br /> Date: <br /> Efm 45.03 7 <br /> ,. T• VA-L iA 1!119 K• 1APM Nn AM <br />