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]P.JNVIRONMENTAL HEALTH DEPARTMENT <br /> SAN JOAQUIN COUNTY <br /> 1868 E. Hazelton Avenue <br /> Stockton, ''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 'A'aste 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: 9 a 1 0, Cfi U Fo 9--0 1 A ST(ZZL I <br /> 67-br Mk) CA q5 2-D L <br /> t4— <br /> City State Zip Code <br /> Phone Number: W ) qb&- AD 75- <br /> Type of Facility or Business: -6A <br /> REGISTRATION FOR: - <br /> ❑ 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'rreatment(Generates 200 lbs ormore/month). <br /> Person responsible for implementation of the Medical Waste Management Plan: <br /> Name: <br /> Title: <br /> Phone:_ I.N"l 5 Date: <br /> 1. List the types of medical waste generated at your facility(i.e. laboratory wastes, blood or body <br /> fluid sharps coma mated i I h 0, 11 <br /> T , mia s urgical specimens, trace chenio or isolation wastes): <br /> n <br /> a) Do you generate My pharmaceutical waste(expired,spent,partials,patient returns)?n Yes At'No <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 /> END 45-03 <br /> 2015 5 <br /> 1k J <br />