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MAY/13/2011/FRI 13: 48 P. 006 <br /> GUIDEL: S FOR THE NIEDICAL ''VV.A.STE MANAGEMENT <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 /> Enviromnental Health Department. The Medical Waste Management Plan shall contain the <br /> following information as appropriate for your facility: <br /> Business Name: 0 i' A S lS r� <br /> Business Address: <br /> mcoaAc_ Cly. X153 a3- <br /> city State Zip Code <br /> Phone Number: <br /> Type of Facility or Business: ha t w S[S CA-aLG <br /> REGISTRATION FOR: <br /> ❑ Small Quantity Generator with Onsite Treatment(Generates less than 2001bs/month). <br /> Large Quantity Generator Only(Generates 200 lbs or more/month). <br /> ❑ Large Quantity Generator with Onsite Treatment(Generates 200 lbs or Snore/month). <br /> Person responsible for implementation of the Medical Waste Management Plan: <br /> ���} Iytii cccx.� Sv vuSu�/ <br /> Name: b,(� Title: (� <br /> Phone: Date: �( 'Zd <br /> 1. List the types of medical waste generated at your facility,i.e.,laboratory wastes,blood or body <br /> fluids,sh s,contaminated Animals surloal specimens,trace chemo or isolation wastes` <br /> a) Do you generate am pharmaceutical waste(expired/outdated,spent,partials,)? <br /> b) Dq Yes ❑No <br /> If yes,describe the type of pharmaceutical waste(expired,spent,partials,outdated,patient <br /> returns,etc): c <br /> �exo�r �eG�S o f U CoIIeG{ ( d(spaCr��Cc <br /> 1 6r�Xe -- <br /> And estimate the Monthly amount of pharmaceutical waste generated at your <br /> facility: <br /> PAM 45-03 5 <br /> 10/6!2006 <br />