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EM <br />1868 E. Hazelton Avenue <br />Stockton, California 95205 <br />Telephone: (209) 468-3420 <br />Fax: (209) 468-8392 <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 Department. <br />The Medical Waste Management Plan shall contain the following information as appropriate for your <br />facility: 1% <br />Business Name: <br />Business Address: <br />Phone Number: <br />0 Type of Facility or Business: <br />I: i X(4 KI I t' V [6) C I IMA <br />City <br />6 94r, <br />1-M <br />State Zip Code <br />❑ Small Quantity Generator with Onsite Treatment (Generates less than 200 lbs/month). <br />Large Quantity Generator Only (Generates 200 lbs or more/month). <br />❑ Large Quantity Generator with Onsite Treatment (Generates 200 lbs or more/month). <br />Person responsible for implementation of the Medical Waste Management Plan: <br />Name- Y - <br />Phone. m�A-VVMI -Date: <br />AbIaLm- <br />1. List the types of medical waste generated at your facility (i.e. laboratory wastes, blood or body <br />LL fluids, sharps, cop!aminated animals, surgical specimens, trace chemo or isolation wastes): <br />a) Do you generate M pharmaceutical waste (expired, spent, partials, patient returns)? XYes ❑ No <br />gye�s, describe the type of pharmaceutical waste (expired, spent, partials, patient returns): <br />And estimate the monthly amount of pharmaceutical waste generated at your facility: bmNakl& <br />GHQ 45-03 5 <br />2015 <br />