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GUIDELINES . <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 N <br />Business Address: 7 ,5'o S" 'e!4'W.'sc:e_ L'®�✓a' <br />ST0c14 -rod CA 9sao`� <br />City State Zip Code <br />Phone Number: ( '2'C> 9 ) 95,s--3001 <br />Type of Facility or Business: Mc -In, t c.G' 1Se p,,/ S'v,gG� Pg -x/ ,O— <br />REGISTRATION FOR: <br />❑ Small Quantity Generator with Onsite Treatment (Generates less than 2001bs/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: rC,,•�,✓A ,Il /~ e7i Title: Ad'V.- 1e s >/rQ N/i d a/ <br />Phone: d09 ---'!r1-3 Date: S`"z '�0 y <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 />I QA, . cis $ 1, bd v� }ten el„��eM s.?i, 41Zf-fl-a/ � cCO.1-4✓-3 <br />a) Do yor generate an pharmaceutical waste (expired/outdated, spent, partials,)? <br />b) 'es ❑ 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If yes, describe the type of pharmaceutical waste (expired, spent, partials, outdated, patient 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: 40 <br />EHD 45-03 <br />10/6/2006 <br />( AjT&A— <br />