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GUIDUINES <br /> (Please 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 /> (FHS-EHD). The medical waste management planshall contain the following information, <br /> as appropriate for your facility: <br /> Business Name: ( (l i <br /> Business Address: v a1 <br /> Business Phone: ( 1 l <br /> Type Of Facility Or Business: _1' i <br /> Registered As: (Check e) <br /> O <br /> Small Quantity Generator With i rea t. (Generates < 200 lbs./mo.) <br /> ( Large Quantity Generator. (Generates lbs. or more/ o.) <br /> ( ) Large Quantity Generator With Onsite Treatment. (Generates 200 lbs.or more/ o.) <br /> Person Responsible For Implementation e Plan: <br /> Name: <br /> Title: Q LIC-C6 Mar <br /> Phone: ( 1 se <br /> ATTACH ADDITIONALTIO <br /> 1. List the types of medical waste generated at your facility, i.e., Laboratory Wastes, <br /> Blood or Body Fluids, Sharps, Contaminated Animals, Surgical Specimens, or <br /> Isolation Wastes. (See "Regulated a 'c Wastes" on Page 3.) <br /> 2. Estimate the monthly amount of medical waste generated at your facility. <br /> 3. Describe the medical waste handling procedures utilized by and applicable to your <br /> facility: <br /> a. Onsite location and method forsegregation, containment, packaging, <br /> labelling, and collection. <br /> -C . E- <br />