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GUIDELINES FOR THE MEDICAL WASTE MANAGEMENT <br />PLAN <br />Small quantity generators that provide Onsite Treatment and all large quantity generators <br />shall have a Medical Waste Management plan on file with the San Joaquin County <br />Environmental Health Department. The Medical Waste Management Plan shall contain the <br />following information as appropriate for your facility: <br />Business Name: S a� K ' �'� ��, e t2j Ce &t <br />Business Address: $� % �a 14 v �- <br />�� t lv �-► CA 9Srzo `7 <br />City State Zip Code <br />Phone Number: ( 7 ag ) 97 Fes" 20 G <br />Type of Facility or Business: 4'., hu /� a"`) JI, `� �, ; Ce.,'¢P' <br />REGISTRATION FOR: <br />Small Quantity Generator with Onsite Treatment (Generates less than 200lbs/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 implementation of the Medical Waste Management Plan: <br />Name: I'A fr-in, A/, /ev-f Title: A 141 i/It f /,-" <br />Phone: ZU 9— S-/ 3 7 2 c) y Date: 3 / zs/a T <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 />p <br />t. .4 a�o� 4 f'l k, _� '5c- <br />a) <br />U <br />a) Do ou generate any pharmaceutical waste (expired/outdated, spent, partials,)? <br />b) [Yes ❑ No <br />If yes, describe the type of pharmaceutical waste (expired, spent, partials, outdated, patient <br />returns, etc): <br />And estimate the monthly amount of pharmaceutical waste generated at your <br />facility: ,,,, <br />EHD 45-03 <br />10/6/2006 <br />