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Phone: ( ) <br /> g. Name,address and phone number of Offsite Treatment Facility where pharmaceutical <br /> waste is transported for treatment,if different than pharmaceutical waste hauler: <br /> Name: <br /> Address: <br /> City State Zip Code <br /> Phone: ) <br /> h. All medical waste generators are required to keep accurate records regarding <br /> containment, storage, hauling,treatment and disposal. All medical waste records area to <br /> be maintained and available for review during inspection for three(3)years. Do you <br /> have tracking documents for all medical wastes handled at your facility: ❑ Yes❑No <br /> i. Describe training provided to staff regarding handling, storage, disposal,and record <br /> keeping of all medical waste,including pharmaceutical waste, at your facility: <br /> C'/ <br /> 14h A04 JkWTYM- D <br /> j. Describe your medical waste emergency action plan, including procedures for <br /> handling spills, exposures, equipment failures, etc: <br /> J <br /> U <br /> I hereby certify to the best of my knowledge and belief that the statements made herein are <br /> correct and true. <br /> Signature: Elu,6 k o <br /> Printed Name: Oj(IV/- <br /> Title: <br /> l <br /> Date: AIN <br /> EHD 45-03 7 <br /> 10/6/2006 <br />