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Phone: (561) 2-7 5 - l l t <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: Q-1-1'v11 <br /> Address: 50 '1100 <br /> � <br /> f- (A+ c� <br /> City State Zip Code <br /> Phone: ( d ) 5S <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 /> i. Describe training provided to staff regarding handling,storage,disposal,and record <br /> keephIg of al medicol w ste 19clIt V <br /> a maceutic waste,at yo facility: <br /> V-R-C44-16 A3 ! 75 addlv c <br /> SC YsG tg V "G l <br /> f� ® �l <br /> j. Describe your medical waste emergency action plan, including procedures for <br /> handling spills,exposures, equipment f ilures, etc: <br /> LJ---s t'-Lo C� Lt s+_ff'_ :S+cR int, fir, <br /> 4 <br /> e - �S rsG <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 /> Printed Name: CZC� A <br /> Title: <br /> Date: ( i / d <br /> EHD 45-03 7 <br /> 10/6/2006 <br />