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Phone: ( IPO) y2 q, <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: VAPjCB 4r <br /> Address: 4I &C S L <br /> ? <br /> CA- 9 3 5 <br /> City State Zip Code <br /> Phone: (j9I 1 e3 I/ - (o Z4-2- <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 /> SA-rCLLtT"E Etl-C)V 10e1) ANtat li IUOO P Aw(N6 apt <br /> S i &S rLL 7 S fMrIQV t-t-JT" U I 3 YJ a tit t`f <br /> �ltt�tc �yAfF quo i rr� � Ptr'Ly HO y 0P -A5 6vt- . <br /> j. Describe your medical waste emergency action plan, including procedures for <br /> handling spills, exposures, equipment failures, etc: S'Fgoutes <br /> C W—trt i mG A kl yt'tal Of-i /''0 P-A--ri0 0+- OtOle#- <br /> hog 1'0v$FG. P-A,-P It Y At LAC'a t`O C nl UP ANY SPtuS- <br /> /P os dl F 'A�-- <br /> I hereby certify to the best of my knowledge and belief that the statements made herein are <br /> correct and true. <br /> Signa re: <br /> Printed Name: <br /> Title: 9;0/q eP i C*1 nt'-N/ 01 C'I k-3) <br /> Date: I(�of-/17 <br /> EHD 45-03 7 <br /> 10/612006 <br />