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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: Ale C%, CA I C,1 4Z <br /> Address: t u o <br /> U . 5"[-k i-ak,- u,]' <br /> City State Zip Code <br /> Phone: (wl ) C13(1 l SSS <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 /> L Describe training provided to staff regarding handling, storage, disposal,and record <br /> keeping of all medical waste,including pharmaceutical waste at your facility: <br /> 52VtS �c� `°! !� i1 <br /> j. Describe your medical waste emergency action plan, including procedures for <br /> handling spills,exposures, equip ent failures, etc: <br /> � <br /> ',3'JV t 6((AC C kLf Cc k QY1d1 t�Gc <br /> a <br /> I hereby certify to the best of my knowledge and belief that the statements made herein are <br /> correct and true. <br /> If <br /> Signature:),&AAdaz4A9na4 <br /> Printed Name: t p_y e c, el "L <br /> Title: ` �nw1 1 r a <br /> Date: (10 -ZGI- IZ <br /> EHD 45-03 7 <br /> 10/6/2006 <br />