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GUIDELINES FOR THE MEDICAL WASTE MANAGEM64T <br />(Please Type or Print) <br />EN'141113(fi�41,-,!ILNIN HEALTH <br />Small quantity generators that provide onsite treatment and all largd4ftWt�P�m8rs <br />shall have a medical waste management plan on file with the local enforcement agency <br />(PHS-EHD). The medical waste management plan shall contain the following information, <br />as appropriate for your facility: <br />Business Name: LINCOLN FAMILY MEDICAL GROUP INC. <br />Business Address: 800 DOUGLAS ROAD STOCKTON , CA 95207 <br />Business Phone: ( 209 ) 957-7050 <br />Type Of Facility Or Business: MEDCAL GROUP <br />Registered As: (Check One) <br />Small Quantity Generator With Onsite Treatment. (Generates < 200 lbs./mo.) <br />0) Large Quantity Generator. (Generates 200 lbs. or more/mo-) <br />Large Quantity Generator With Onsite Treatment. (Generates 200 lbs. or more/mo.) <br />Person Responsible For implementation Of The Plan: <br />Name: SHEILA M. FREDERICKSEN <br />Title: UNTRAI r,11PP1 Y N11PSING DERI Phone: ( No )957-7050 ENT.# 661 <br />ATrACH ADDITIONAL INFORMATION <br />1. list the types of medical waste generated at your facility, i.e., Laboratory Wastes, <br />Blood or Body Fluids, Sharps, Contan-dnated Animals, Surgical Specimens, or <br />Isolation W astes. (See "Regulated Medical Wastes" on Page 3.) <br />2. Estimate the monthly amount of m dical waste generated at your facility. <br />0 b <br />3. Describe the medical waste handling procedures utilized by and app c e to your <br />facility: <br />a. Onsite location and method for segregation, containment, packaging, <br />labelling, and collection. t) 0 C -L -e <br />-CONTINID ON REV M -SE- �-c <br />7 <br />