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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: <br />Address: ) i -') ice. <br />Z/oSv <br />City State Zip Code <br />Phone: AC:1 0 <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: q es ❑ 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 ffcility: <br />Tri! <br />j. Describe your medical waste emergency action plan, including rocedures for <br />handling spills, exposures, equipment failures, etc: <br />M <br />MW M <br />CLA k3 <br />I hereby certify to the best of my <br />correct and true. <br />Signature: l <br />Printed Name: <br />Title: 1 <br />Date: 1 <br />nowledize and belief that the statements made herein are <br />EHD 45-03 7 <br />10/6/2006 <br />