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GUIDELINES FOR THE MEDICAL WASTE MANAGE1kIENT PLAN <br /> (Please Type or Print) " }-1 )j$ <br /> 'fifY:�'ti <br /> Small quantity generators that provide onsite treatment and ally F generators <br /> shall have a medical waste management plan on file with the local'e 0b ency <br /> (PHS-EHD). The medical waste management plan shall contain the following information, <br /> as appropriate for your facility: <br /> Business Name: 4! O � <br /> � c � '7�''�� <br /> Business Address: �l .Syl�i� �z 9,` z g <br /> Business Phone: (Z-Oq -� ��` 'LK/ <br /> Type Of Facility Or Business: <br /> Registered As: (Check One) <br /> ( ) Small Quantity Generator With Onsite Treatment. (Generates < 200 lbs./mo.) <br /> (.� Large Quantity Generator. (Generates 200 lbs. or more/mo.) <br /> ( ) Large Quantity Generator With Onsite Treatment. (Generates 200 lbs.or more/mo.) <br /> Person Responsible For Implementation Of The Plan: <br /> Name- <br /> Title: <br /> ATTACH ADDITIONAL INFORMATION <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 Was es. (See "Regulated Medical Wastes" on Page 3.) Clas s <br /> �, <br /> 2- Estimate the monthlv'amount of medical waste genamted at your facility. <br /> 580 Pounds <br /> 3. Describe the medical waste handing procedures utilized by and applicable to your <br /> facility: <br /> a. Onsite location and method for segregation, containment, packaging, <br /> labelling, and collection. <br /> -CONTINUED ONREVERSE- <br /> 7 <br />