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Phone: ( 1 <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: <br /> Address: <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. Do you <br /> have tracking documents for all medical wastes handled at your facility: VYes❑No <br /> i. Describe training provided to staff regarding handling, storage,disposal,and record <br /> epm of all me a waste, including phar eutical waste,at yo r fac(lit, <br /> 5 d <br /> j. Describe your medical waste emergency action plan incl ing procedures for, <br /> handlin sills,�ex�,Vosuures, e ui ient fail res, etc: <br /> - <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:a t <br /> Title: <br /> Date: " J °( <br /> EHD 45-03 7 <br /> 10/6/2006 <br />