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0 4P <br />ENVIRONMENTAL HEALTH DEPARWt"�.. <br />SAN JOAQUIN COUNTY <br />304 East Weber Avenue, Third Floor JUL 12 2005 <br />Stockton, California 95202 ENWONMENT HEALTH <br />Telephone: (209) 468-3420 �M1T IRV1(;ES <br />Fax: (209) 468-3433 <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: <br />Business Address: <br />Phone Number: <br />Type of Facility or Business <br />1 1. <br />a <br />-hoo <br />City State Zip Code <br />(aO9) - 70S-0 <br />L. DI C14 L U FFl <br />❑ 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 responsible for implementation of the Medical Waste Management Plan: <br />Name: Sj:Cyahatn1e, M11kr Title:J �t ���/ 0�c r <br />Phone: Date: <br />1. List the types of medical waste generated at your facility, i.e., laboratory wastes, blood or body <br />fluids, sharps, contaminated animals, surgical specimens, trace chemo or isolation wastes": <br />0 <br />a) Do you generate any pharmaceutical waste (expired, spent, partials, outdated)?JSj Yes ❑ No <br />EHD 45-03 Page 1 <br />6/8/05 <br />