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F] <br />GUIDELINES 1 <br />PLAN <br />Small quantity generators that provide Onsite Treatment and all large quantity generators <br />shall have a Medical Waste Management plan on file with the San Joaquin County <br />Environmental Health Department. The Medical Waste Management Plan shall contain the <br />following information as appropriate for your facility: <br />Business Name: J 1 Tt1= / C Il/5/1 <br />Business Address: 1 <br />Ido <br />City State Zip Code <br />Phone Number: ( ) <br />n, r <br />Type of Facility or Business: )� <br />REGISTRATION FOR: <br />❑ Small Quantity Generator with Onsite Treatment (Generates less than 200lbs/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 />j <br />QM1W- ISWtr)�- <br />Name:Title: 1 ' <br />Phone: -` �3 Date: L6 <br />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 />a) Do you generate gLny pharmaceutical waste (expired/outdated, spent, partials,)? <br />b) Yes ❑ No <br />If yes, describe the type of pharmaceutical waste (expired, spent, partials, outdated, patient <br />returns, ,etc): A . , <br />And estimate the monthly amount of pharmaceutical waste generated at your <br />facility: s, <br />EHD 45-03 5 <br />10/6/2006 <br />