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Phone: ( ) <br />g. Name, address and phone number of Offsite Treatment Facility where pharmaceutical <br />waste is transported for treatment, if different than pharmaceutical waste hauler: <br />Name: <br />Address: <br />City State Zip Code <br />Phone: { ) <br />h. All medical waste generators are 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. Do you <br />have tracking documents for all medical wastes handled at your facility: ❑ Yes ❑ No <br />Describe training provided to staff regarding handling, storage, disposal, and record <br />keeping of all medical waste, including pharmaceutical waste, at your facility: <br />j. Describe your medical waste emergency action plan, including procedures for <br />handling spills, exposures, equipment failures, etc: <br />..�a.�cI — P_ t �►�-1— z ? ©.�1 .�t. � F �f— � <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 />PrintedName: <br />Title: -7 - <br />Date: <br />Date: zo ® g <br />ERD 45.03 <br />10/6/2006 <br />