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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: SMOCVCLE C - <br />Address: 41`x„C-;WlfT- AVE <br />7 <br />z 2 - <br />city State Zip Code <br />Phone: 1) ?-75- 0994- <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: AYes ❑ No <br />i. 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, <br />handling spills, exposures, equipment failures, etc: _ <br />Ail fes- I N CLi N i C. <br />W� <br />for <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: s <br />Title: <br />czilyt6-v- A�;01 fe-&Ivy- <br />Date: <br />EHD 45-03 7 <br />10/6/2006 <br />