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GUIDELINES FO THE MEDICAL WASTE MANAGEMENT <br />Small quantity generators that provide onsite treatment and all large quantity generators <br />medical waste management plan on file with the San Joaquin County Environmental Health <br />The medical waste management plan shall contain the following information as appropi <br />facility. <br />Business Name <br />om MR <br />shall have a <br />Department, <br />iate for your <br />Business Address Business Phone 1ZZ7 -BGG Z,/ <br />Type of Facility or BusinessL�-� <br />REGISTRATION FOR: <br />Small Quantity Generator with onsite treatment (Generates less than 200 lbs/month) <br />Large Quantity Generator Only (Generates more than 200 lbs/month) <br />Large Quantity Generator with onsite treatment (Generates 200 lbs or more/month) <br />Person Responsible for Implementation of the Plan: <br />Name 2�i �'��1i � � Title D IV > Phone (21 � r`�7 <br />1- List the types of medical waste generated at your facility, i.e. laboratory wastes, blood or body fluids, <br />sharps, contaminated animals, surgical specimens, or isolation wastes. (See "Regulated Medical <br />Wastes" listed on Page 2.) <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 facility, including, <br />but not limited to, the following: <br />5 c-, CaA� d ,e sc r �e "o L, -P c eu-t + C'--O-V-a'E;>✓e v�d t �n� � p ,�i, Sj <br />a- Onsite location and method for segregation, containment, packaging, labeling, and collection. <br />b- Storage area description with storage methods utilized, including duration and temperature <br />controls, if applicable. <br />c- Onsite treatment facility description, including type of treatment utilized, maximum capacity, <br />time and temperature necessary, alternate contingency plan in case of equipment failure, etc. <br />d- Name, address, registration number, and phone number, of the registered hazardous waste <br />hauler employed by your facility. <br />e- Name, address, and phone number of offsite treatment facility where medical waste is <br />transported for treatment, if different than hauler. <br />f- Do you have a Limited Quantity Hauling Exemption? Who on your staff is authorized to <br />transport your medical waste? <br />g- Do you have tracking documents for all medical wastes handled at your facility? All medical <br />waste generators are required to keep accurate records regarding containment, storage, <br />hauling, treatment, and disposal. All medical waste records area to be maintained and <br />available for review during inspection for 3 years. <br />h- Describe your medical waste emeraencv action plan, including procedures for handling spills, <br />exposures, equipment failures, etc. (See Appendix A) <br />I hereby certify to the best of my knowledge and belief that the statements made herein are correct and true. <br />� <br />SIGNATURE CSG - � TITLE �` .DATE -/ 5� - <br />