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0 - 0 <br />zlt. 1 140 * - <br />1868 E. Hazelton Avenue <br />Stockton, California 95205 <br />Telephone: (209) 468-3420 <br />Fax: (209) 468-8392 <br />Small quantity generators that provide onsite treatment and all large quantity generators shall have a <br />Medical Waste Management plan on file with the San Joaquin County Environmental Health Department. <br />The Medical Waste Management Plan shall contain the following information as appropriate for your <br />facility: <br />Business Name: P)N--V - <br />Business Address: <br />city State Zip Code <br />Phone Number: 0114 <br />Type of Facility or Business: <br />REGISTRATION FOR: - - <br />F] Small Quantity Generator with Onsite Treatment (Generates less than 200 lbs/month). <br />Large Quantity Generator Only (Generates 200 lbs or more/month). <br />❑ Large Quantity Generator with Onsite Treatment (Generates 200 lbs or more/month). <br />Person responjible for implementation of the Medical Waste Management Plan: <br />Name: Title: - <br />Phone: C 9Pj-J Date: <br />1. List the types of medical waste generated at your facility (i.e. laboratory wastes, blood or body <br />fluids, sh, contaminated animals, surgical specimens, trace chemo or isola�qp wastes): <br />IM_ -/'U= - , - - I . <br />a) Do you generate any pharmaceutical waste (expired, spent, partials, patient retums)?E] Yes F] No <br />If yes, describe the type of pharmaceutical waste expired, spent, partials, patient returns): <br />W. <br />And estimate the monthly amount of pharmaceutical waste generated at your facility: LkO\-b�> <br />FHD 45-03 <br />2015 <br />