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it i • • i a r <br />(Please Type or Print) <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 local enforcement agency <br />(PHS-EHD). The medical waste management plan shall contain the following information, <br />as appropriate for your facility: <br />Business e• Lodi Memorial Hospital West <br />Business Address: 800 South Lower Sacramento Road <br />Business Phone: (209 ) 333 3411 <br />General Acute Care Hopsital <br />Registered : (Check One) <br />()Small Quantityfor With Onsite Treatment. (Generates < 200 lbs./mo.) <br />( e Quantity Generator. (Generates 200 lbs. or more/o.) <br />Large Quantity Generator With Onsite Treatment.10 . <br />RichardPerson Responsible For Implementation Of 'The Plan: <br />Title: Administrator Phone: (209 ) 334 3411 Ext. 7560 <br />� �« � rr • li •• • <br />1 List the types of medical waste generated at your facility, i.e., Laboratory Waste <br />LI••• or Body Fluids,Sharps, Contaminated Animals, Surgical Specimens,• <br />• •"Regulate• • • <br />.- <br />2. r . • • • • • <br />`•• • 111 •• • <br />3.11 <br />De -• • • • applicable s • <br />a. Onsite locationand •••segregation,• packaging, <br />labelling, and collection. See Attachment B <br />• —#v r • <br />7 <br />