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Do you operate a common storage facility? NO <br /> If so,please list on a separate sheet the business address of ach small quantity generator pooling <br /> his medical waste in this facility. NO <br /> Will you apply or have applied for a limited quantity haulh g exemption?NO <br /> If so, who on your staff is authorized to haul? Title: <br /> Please list on a separate sheet the names of additional staff uthorized to haul medical waste. <br /> Name of facility where waste is hauled: <br /> Address: <br /> Will medical waste be hauled to a treatment facility other t an used by your medical waste <br /> hauler?NO <br /> If so, Please give name and address of facility: <br /> Are there generators in the same building,or operating in ifferent buildings on the same or <br /> adjacent property, with whom you have registered as one enerator of Medical Waste?NO <br /> If so, please list on a separate sheet the name and address f each facility. <br /> In the event of failure of the plan described above, (e.g. -dical waste hauler is unable to pick- <br /> up the medical waste at the designated time), what will b the alternative method of treatment <br /> and/or disposal of medical waste. We will treat medicallaste in the autoclave in an <br /> appropriate red bag,sterilize and dispose of the treat . waste waste and keel) records to the <br /> treatment. <br /> What will you do if medical waste is spilled? <br /> 1. Employee must wear heavy duty nitrile rubber gl ves,a fluid resistant gown and safety <br /> goggles or face shield with mask. <br /> ' <br /> 2. A vacuum regular or wet/dry vacuum MA Y NOT be used to clean-up broken glassware. <br /> 3. Broken glassware which may be contaminated must be cleaned up using mechanical <br /> means,such as a brush and dust pan., tongs,or to ceps-never directly with hands. The <br /> 0 , <br /> broken glassware must be discarded in the sharp container. <br /> 4. After removing the glass,dispose of glass in the harps container. <br /> 1 <br /> 5. Soak up the spill with disposable paper towels. ispose of paper towels in a plastic red <br /> biohazardous;waste bag. <br /> 6. Disinfect the area, using the intermediate level d, sinfectant, following the manufactures <br /> contact time. <br /> 7. Remove personal protective equipment and was hands. <br /> Note: Medical waste generators must keep accurate rec -rds relative to storage,hauling,treatment <br /> and disposal of medical waste. <br /> T� t wfvr r,a owa � i-I A &_"Je_ <br /> 6 <br /> VIt " I I %I_Z11- b py <br /> t�4�'"MV8 <br />