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Phone: (5/®) `< 9- q911 <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 /> I Li <br /> Name: Aee At,)io n rn erg <br /> Address: D O'74 k ���e� <br /> /O� �a'� <br /> Ci State Zip Code Jt1(� <br /> Phone: (701) '�F.? - 7.3 73 l <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 harmaceutical waste,at your facility: <br /> ...1 C -' IM n u -!re - Gi GL <br /> j. Describe your medical waste emergency action plan, including procedures or a <br /> handling spills, exposures, equipment failures, etc: <br /> filx -� bLdl � 4"I- Lam. r bye <br /> c� ✓� ,I �� are- e � �-� <br /> -'a wov- I <br /> ,U,-s,(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: <br /> Printed Name: (-c <br /> Title: 1-e6'�LAL leo.(L1 iS O-r- <br /> Date:t �� Z-D <br /> EHD 45-03 7 <br /> 10/6/2006 <br />