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OZZO'ONW' :Z ZIOZ 'til'Lsnb ;UJIJ pania3;� <br />Phone: <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 <br />Phone: <br />State Zip Code <br />h. All inedical 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 leo you <br />have tracking documents for all medical wastes handled at your facility: Vy les ❑ No <br />1. Describe training provided to staff regarding handling, storage, disposal, and record <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 spils, exposures, equipment failures, etc:���1`5 c`P_.aneck usI'A b <br />0 <br />\ad) <br />e e• A y e /t a .� e e e <br />% e r <br />X hereby certify to the best of my knowledge and belief Haat the statements made herein are <br />correct and true. <br />Signature" 1��� -.s., �1 <br />Printed Name: ,)�Aa-no' 0�'n �N t <br />'title: ��C,t�� �Gy �►®p��/l�i�`�( C e CIC' d; Aa --6 C <br />Date: <br />EFtn 45,03 <br />10/6/2006 <br />7 <br />OL/Z d 26£88MOZ << W� L tL-80-2LOZ <br />