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3 0 <br /> Registration#: , <br /> f. Name, address and phone number of Offsite Treatment Facility where biohazardous <br /> (excluding pharmaceutical waste) and sharps waste is transported for treatment, if different than <br /> hauler: <br /> Name: <br /> Address: <br /> CItV State Zip Code <br /> Phone: <br /> g. Name, address and phone number of Offsite Treatment Facility where pharmaceutical waste <br /> is transported for treatment, if different than pharmaceutical waste hauler: <br /> Name: <br /> Address: m <br /> City S t Zip Code <br /> Phone: �- <br /> 9 <br /> I/- <br /> h. All medical waste grheors are required to keep accurate records regarding containment, <br /> storage, hauling, treatment and disposal. All medical waste records area to be maintained and <br /> available for review during inspection for three 3) years. Do you have tracking documents for <br /> all medical wastes handled at your facility: CWYes ❑ No <br /> i. Describe training provided to staff regarding handling, storage,disposal and record kee ing,o <br /> a medi al ante, including ha acetical a e, at your fac• ity: D <br /> t <br /> Q <br /> j. Describe your medical waste emergency action plan, including procedures for handlings it > <br /> expo r s, e uipMent failures, et <br /> a <br /> 4 <br /> e <br /> e <br /> I <br /> I hereby certify W the best of my knowledge andelle a the statements made herein are correct and true. <br /> Signature: Title: <br /> Date: <br /> EHD 45-03 Page 3 <br /> 6/8/05 <br />