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GUIDELINES FOR THE MEDICAL WASTE MANAGEMENT <br /> PLAN <br /> Small quantity generators that provide Onsite Treatment and all large quantity generators <br /> shall have a Medical Waste Management plan on file with the San Joaquin County <br /> Environmental Health Department. The Medical Waste Management Plan shall contain the <br /> following information as appropriate for your facility: <br /> Business Name: <br /> G S <br /> Business Address: 1� AI� <br /> Sb(,,,L MA CA <br /> SZ-1 C� <br /> City State (� ^ Zip Code <br /> Phone Number: ( ?Zol ) <br /> Type of Facility or Business: Ic i uu-Y l <br /> REGISTRATION FOR: <br /> ❑ Small Quantity Generator with Onsite Treatment(Generates less than 200lbs/month). <br /> ❑r Large Quantity Generator Only(Generates 200 lbs or more/month). <br /> ❑ Large Quantity Generator with Onsite Treatment(Generates 200 lbs or snore/month). <br /> Person responsible for implementation of the Medical Waste Management Plan: <br /> Name: - d Title: <br /> Phone: `��` Date: �` d <br /> 1. List the types of medical waste generated at your facility,i.e., laboratory wastes,blood or body <br /> fluids, sh s, contamin ted ani ls,sur icSal specimens,trace chemo oriso1ption was <br /> a t:11 <br /> es <br /> isok Loa— <br /> a) Do you generate an pharmaceutical waste(expired/outdated, spent,partials,)? <br /> b) ®'Yes ❑No <br /> If yes, describe the type of pharmaceutical waste(expired,spent,partials, outdated,patient <br /> returns,-etc)• <br /> And estimate the}}m�onthly amount of pharmaceutical waste generated at your <br /> facility: t h`> <br /> EHD 45-03 5 <br /> 10/6/2006 <br />