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Wi <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />SAN JOAQUIN COUNTY <br />1868 E. Hazelton Avenue <br />Stocktonj ' 'alifornia 95205 <br />Telephone: (209) 468-3420 <br />Fax: (209) 468-8392 <br />GUIDELINES FOR THE MEDICAL WASTE MANAGEMENT PLAN <br />Small quantity generators that provide onsite treatment and all large quantity generators shall have a <br />Medical Waste Management plan on file with the San Joaquin County Frivironmental Health Department. <br />The'Medical Waste Management Plan shall contain the following information as appropriate for your <br />facility: <br />Business Name: <br />Business Address: 19DI 0, CfiU f:b 9-01 A ST(ZZLI <br />67-br Mk) CA q5 2-D L <br />t4— <br />City State Zip Code <br />Phone Number: W)"! b&- AD 75- <br />Type of Facility or Business: <br />REGISTRATION FOR: - <br />[I Small Quantity Generator with Onsite Treatment (Generates less than 200 lbs/month). <br />Large Quantity Generator Only (Generates 200 lbs or more/month). <br />❑ Large Quantity Generator with Onsite 'treatment (Generates 200 lbs ormore/month). <br />Person responsible for implementation of the Medical Waste Management Plan: <br />Name: <br />Title: <br />Phone:_ 'I. N"15 Date: <br />1. List the types of medical waste generated at your facility (i.e. laboratory wastes, blood or body <br />fluid sharps, D mated coma t d i nimachemorgical specimens, trace chemo or isolation wastes): <br />0ds 5 U <br />_L_ V -P5 <br />END 45-03 <br />2415 <br />a) Do you generate My pharmaceutical waste (expired, spent, partials, patient returns)? n Yes ArNo <br />If yes, describe the type of pharmaceutical waste (expired, -spent, partials, patient returns): <br />And estimate the monthly amount of pharmaceutical waste generated at your facility: <br />