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06/09/2005 14:10 4640138 ENVIRONMENTAL HEALTH PAGE 04 <br /> Registration 4: L fi —o_ D 2 2— <br /> f. Name,address and phone number of Mite Treatment Facility where biobazardous <br /> (excluding pharmaceutical waste) and sharps waste is transported for treatment, if different than <br /> hauler: <br /> Name: c4cle <br /> Address. 4113:5: 4,4 5' 1±1: <br /> -7Z2- <br /> Citv Stt zip Code <br /> ;Z7757 <br /> Phone: CY5 <br /> g. Name, address and phone number of()Offsite Treatment Facility where pharmaceutical waste <br /> is transported for treatment, if different than pharmaceutical waste hauler: <br /> Name: <br /> Address: <br /> City State Zip Code <br /> Pborie: <br /> h. All medical waste generators are required to keep accurate records regarding containment, <br /> storage,hauling,treatment and disposal. All medical waste records area to be maintained and <br /> available for review during,inspection for three(3) years. Do you have tracking documents for <br /> all medical wastes handled at your facility: V�'es El No O+L M� 10-Q- <br /> -42.e M&&t4-� <br /> i. Describe training provided to staff regarding handling, storage, disposal, and record keeping of <br /> all ni dicalw te, including pharmaceutical waste. at your facility:- <br /> 4 <br /> AA <br /> ce, <br /> J Des 'be your medical waste emergency action plan, including procedures for handling spills, <br /> exposures,equipment failures, etc- <br /> 0, 'P <br /> I hereby certify to the best of my knowledge clief that the statements made herein are correct and true. <br /> Signature: Title-. <br /> Date: <br /> Elit)45-0.1 Page 3 <br />