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",Npc"irq lion Care cantar <br /> b i..,o rri31 $mil 'C II'Cle <br /> Sstamktorl CA 95210 <br /> Phone: Q)j) -300 t <br /> g. Name,address and phone number of Offsite Treatment Facility where pharmaceutical <br /> waste is transported for treatment, if different than pharmaceutical waste hauler: <br /> Name: S1 i U <br /> Addresz/010 <br /> C C[ 4 0 _ <br /> City state Zip Code <br /> Phone_ -- <br /> h. All medical waste generators are required to keep accurate records regarding <br /> containment,storage,hauling,treatment and disposal. All medical waste records area to <br /> be maintained and available for review during inspection for three(3)years. Clo you <br /> have tracking documents for all medical wastes handled at your facility- 1";6 Yes E]No <br /> i. Describe training provided to staffregardin! handling„storage,disposal,and nxord <br /> keeping,of all medical waste,including;pharmaceutical waste,at your facility: <br /> j. Describe your medical waste emergency action plan, including procedures for <br /> handling spills,exposures,equipment failures, etc: <br /> I hereby certify to the best of my knowledge and belief that the statements made herein are <br /> correct and true. <br /> Signature: <br /> Printed Name___J�� <br /> Title: _ ,�/�/??/nf,( — <br /> Date: <br /> EI ID 45.03 7 <br /> 1 U/6/zW7 <br /> 9T/L'd 262889tl:01 :WObd ZT:ZT TT02-ET-AUW <br />