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SA N 10 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 /> Business Name: A L, ii rue, st,4-4-� <br /> Business Address: <br /> City State Zip Code <br /> Phone Number: (Zoq ) gqy -9 10 0 <br /> Contact Person: d r� <br /> Type of Facility or Business: <br /> d <br /> Registration for: <br /> ❑ Small Quantity Generator with Onsite Treatment (Generates less than 200 Ibs/month). <br /> Large Quantity Generator Only (Generates 200 Ibs or more/month). <br /> ❑ Large Quantity Generator with Onsite Treatment (Generates 200 Ibs or more/month). <br /> Person responsible for implementation of the Medical Waste Management Plan: <br /> Name: C�r� r'ti Title: M a-�'er� <br /> Phone:_ '09 9 t (-)o Date: 3/2-Y 2. <br /> 1. List the types of medical waste generated at your facility (i.e. laboratory wastes, blood or body <br /> fluids <br /> shaarps, cont��j7linated animals, surgical specimens, trace chemo or isolation wastes): <br /> Do you generate any pharmaceutical waste (expired, spent, partials, patient returns)?,,dYes ❑ No <br /> 6of>> <br />