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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: T tCYLuE 1"x— yNGME¢ianb's <br /> Address: 90 A3. hp T <br /> &mVLTIi i6wr t.Az*c z" tu'r 8 W O t O <br /> City State Zip Code <br /> Phone: 1 ) 4— t S S T <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: R/Yes❑No <br /> L Describe training provided to staff regarding handling, storage,disposal,and record <br /> keeping of all medical waste,including pharmaceutical waste, at your facility: <br /> Fj%zT6'0V- E'-%ftp` GQ r W V%AP *A&'alcA4- Tom. <br /> T12AeNG> CA-4 eftMe- sr[ O-AGt. <br /> j. Describe your medical waste emergency action plan, including procedures for <br /> handling spills, exposures, equipment failures, etc: WE e-O►cs Act. <br /> ?-%V)>tcatL wo%S'M 440 fLA5A W A SecLAta cA,U:;E'r S.hvo:t cU <br /> Peiv mcatcov- w^cTe Foe fnN&,w2 wE witA. %i& a. <br /> 41W,-,(,A" "T® SOq4t'rIZC THE AqZ^ 4A)o Rica T <br /> I hereby certify to the best of my knowledge and belief that the statements made herein are <br /> correct and true. <br /> Signature: A DE <br /> Printed Name: <br /> Title: N1rNtsT '�' <br /> Date: 1® f 3�'13 <br /> EHD 45-03 7 <br /> 10/6/2006 <br />