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--_ <br /> Hazardous Waste Stora a ins ection Farre–To Be Conducted Weekl �y a <br /> DATE INSPECTED_ �0 Banfield Pet Has <br /> 'l.0 6ANFIELDREPRESENTATIVE: <br /> (prink): �.L.t'�t+t Q-Y�l'c 51GNATURE. <br /> CONTAINERS Labeled as Hospitel <br /> (indicate Kpresent) Hazardous Waste Ntwnbey Contents Accinviuladon f <br /> (YINI) Address notes Start Date CONDITION CAPSfLlDS <br /> Expired Pharmaceutic (PINT] (YIN?) (YIN3) (id—df—cicedfetc,) SEALED(YIN!) Leatingl(YIN?) <br /> Waste GT'm Stain ry <br /> Waste Pharmaceuticals <br /> Waste Formalin <br /> "v-T. <br /> FACILITY SPILLILEAK1STAlN FOUNDT <br /> (Y o FIRST AID KIT PRESENT? a No) SPILL SUPPLII25 PRESE <br /> T'll"f a No) <br /> S e <br /> RECORDS - :ri. -• '.'•yy►f•,.,_ <br /> HAZARDOUS WASTE MA (m WM ginder) '' <br /> e Ha) INSPECTION REPORTS(in WM ginder) No) <br /> DATE <br /> COMMENTS f CORRECTIVE ACTION I DISCREPANCY? <br /> INITIALS <br /> N you answered"Vey'to SpYRalLeaks mdlor"No' m any d the ether aetns abw or the condition of the container is inade ua <br /> Canntt Sha direcdy at anti m far.lahels,mntainen,and disposal.E-mail@6anf old enm q te,Please Prowde information on the issue and how k wu rx;olved, <br /> loran 9-"questions m azsisGnce, <br /> esu <br /> DATE INSPECTED- BANFIELO REPRESENTATIVE:(print)_ <br /> L <br /> SIGNATURE- <br /> CONTAINERS Hospital Labeled as - _ - - - <br /> CONTAlNERS Numfierl Contents Accumulation - - <br /> (indicate if present) Hazardous Address noted? Start pate CONDITION CAPSILIDS v t <br /> Waste(YIN?) [Y!N?) (YINa (800dlcrackedfetc") SEALED(YIN?) Leaking.(YIIII <br /> (YIN?] <br /> Expired Pharmaceuticals <br /> Waste Gram Stain <br /> Waste Pharmaceuticals <br /> Waste Formalin <br /> FACILITYSPILULEAK15TA1N FOUND?(YesIN.) FIRST AID K T PRESENT?(Yes1No) SPILL SUPPLIES PRESENT?(YesJNo)' <br /> RECORDS STERICYCLE MANIFESTS(in Safety Binder)(Yesl No) INSPECTION REPORTS(in Safety Hinder)(YesfNo) <br /> DATE COMMENTS l CORRECTIVE ACTION 1 DISCREPANCY? <br /> INITIALS <br /> If you answered"Yea"to Spills/Leaks andlor"No"to any of the ocher hems above,or the condition of the container is inadequate,please prmide'udonnadoo on the issue and how it,moked. <br /> Conmet Sharps directly at 6anfiel _shary ,�orc�.for lahels,conniners,and disposal.E-mail HSE@0jd,eld-cam for any general quesums or assisnnte. ;�x, <br />