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10/12/2022 10:35 FAX <br /> 0005/0006 <br /> SHAWNEnvironmental Health Department <br /> COUNTY <br /> GUIDELINES FOR THE MEDICAL WASTE MANAGEMENT PLAN <br /> Small quantity generators that provide onsite treatment and all large quantity generators shall have a Medical Waste <br /> Management plan on file with the San Joaquin County Environmental Health Department. The Medical Waste <br /> Management Plan shall contain the following information as appropriate for your facility: <br /> Business Name: Davita Grant Line Dialysis <br /> Business Address: 2955 N. Corral Hollow Rd. <br /> Tracy, CA 95376 <br /> City State Zip Code <br /> Phone Number: ( 1 <br /> Contact Person: Courtney Vela Phone Number(if different from above): ( ) <br /> Type of Facility or Business: Dialysis Facility <br /> Registration for: <br /> ❑ Small Quantity Generator with Onsite Treatment(Generates less than 200 lbs/month). <br /> Q Large Quantity Generator Only(Generates 200 lbs or more/month). <br /> ❑ Large Quantity Generator with Onsite Treatrnent(Generates 200 lbs or more/month). <br /> Person responsible for implementation of the Medical Waste Management Plan.- <br /> Name: <br /> lan:Name: Courtney Vela Title:Facility Administrator <br /> Phone:(209) 839-8302 Date: 7/20/2020 <br /> 1. List the types of medical waste generated at your facility(i.e. laboratory wastes, blood or body flL ids, sharps, <br /> contaminated animals, surgical specimens,trace chemo or isolation wastes): <br /> Laboratory waste,blood or body fluids,sharps,pharmaceuticals,and Isolation wastes <br /> Do you generate any pharmaceutical waste (expired, spent, partials, patient returns)? N Yes❑ No <br /> If yes, describe the type of pharmaceutical waste (expired, spent,partials, patient returns): <br /> expired and spent <br /> And estimate the monthly amount of pharmaceutical waste generated at your facility: less than 100 lbs <br /> 2. Estimate the monthly amount of medical waste(excluding waste pharmaceuticals)generated at your facility: 1000 lbs+ <br /> 3. Describe the medical waste handling procedures utilized by and applicable to your facility, inciudiig, but not limited <br /> to the following: <br /> a. Onsite location and method for segregation, containment, packaging, labeling and collection, including <br /> pharmaceutical waste: <br /> Onsite biohazard room locked with medical waste <br /> 5of8 <br />