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6 0 <br />b. Storage area description wip storage methods tilize , incl ding duration and temperature <br />controls, if applicable: -e, <br />c. Onsite treatment facility description, including type of treatment utilized, maximum capacity, <br />time and temperature necessary, alternate contingency plan in case of equipment failure, etc: <br />�- <br />d. Name, address, registration number and phone number of the registered hazardous waste hauler <br />employed by your facility: <br />NamIT <br />e: 1 - <br />Address: e <br />CA - <br />City te. Zip Code <br />Phone: <br />Registration #: <br />e. Name, address and phone number of Offsite Treatment Facility where medical waste is <br />transported for treatment, if different than huler: <br />Name: o,,-. <br />Address: <br />City State Zip Code <br />Phone: ( 1 <br />f Do you have a Limited Quantity Hauling Exemption: El Yes XNo <br />g. Who on your staff is authorized to transport your medical waste? (If more than 3 names, <br />attach a list): <br />List Names: l . <br />2. <br />3. <br />h. All medical waste generators 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: X Yes ❑ No <br />Describe your medical waste emer <br />exposures, equipment failures, etc: <br />ion plan, incltjd)ng proyedures for handling spills, <br />I hereby certifyto he best of my knowledge and belief that the statements made herein are correct <br />r ,�� _ i z V - I e--`+ . i l <br />• err i� :' �%f���� <br />1 11) as -02-001 „en t/ Page 6 of 7 <br />8 14,07 <br />