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SAN10 A Q U I N Environmental 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 <br /> Medical Waste Management plan on file with the San Joaquin County Environmental Health <br /> Department. The Medical Waste Management Plan shall contain the following information as <br /> appropriate for your facility : <br /> S fia � k �� C7 V .� a�i r,,- S LAw � , nk�. L L. C.. <br /> Business Name : <br /> Business Address : <br /> City State Zip Code <br /> Phone Number : (Z09 ) gqy � q 10 0 <br /> Contact Person : �� d r �j <br /> Type of Facility or Business : <br /> d <br /> Registration for: <br /> ❑ Small Quantity Generator with Onsite Treatment ( Generates less than 200 lbs/month ) . <br /> Fr 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 : C � r � r'ti Title : <br /> Phone : _ d9 'z 9 Date : 3/2 yY Q <br /> 1 . List the types of medical waste generated at your facility ( i . e , laboratory wastes , blood or body <br /> fluids ++ sharps , cont��j7linated animals , surgical specimens , trace chemo or isolation wastes ) : <br /> 0A A i dI s <br /> Do you generate any pharmaceutical waste ( expired , spent , partials , patient returns ) ?,,dYes ❑ No <br /> 6of11 <br />