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GUIDELINES FORWE MEDICAL WASTEG ENT 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 Environmental 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 Business Phone <br /> Type of Facility or Business <br /> REGISTRATION FOR: <br /> Small Quantity Generator with onsite treatment(Generates less than 200 lbs/month) <br /> Large Quantity Generator Only (Generates more than 200 lbs/month) <br /> Large Quantity Generator with onsite treatment(Generates 200 lbs or more/month) <br /> Person Responsible for Implementation of the Plan: <br /> Name Title Phone <br /> 1- List the types of medical waste generated at your facility, i.e. laboratory wastes, blood or body fluids, <br /> sharps, contaminated animals, surgical specimens, or isolation wastes. (See "Regulated Medical <br /> Wastes" listed on Page 2.) <br /> 2- Estimate the monthly amount of medical waste generated at your facility. <br /> 3- Describe the medical waste handling procedures utilized by and applicable to your facility, including, <br /> but not limited to, the following: <br /> a- Onsite location and method for segregation, containment, packaging, labeling, and collection. <br /> b- Storage area description with storage methods utilized, including duration and temperature <br /> controls, if applicable. <br /> c- Onsite treatment facility description, including type of treatment utilized, maximum capacity, <br /> time and temperature necessary, alternate contingency plan in case of equipment failure, etc. <br /> d- Name, address, registration number, and phone number, of the registered hazardous waste <br /> hauler employed by your facility. <br /> e- Name, address, and phone number of offsite treatment facility where medical waste is <br /> transported for treatment, if different than hauler. <br /> f- Do you have a Limited Quantity Hauling Exemption? Who on your staff is authorized to <br /> transport your medical waste? <br /> g- Do you have tracking documents for all medical wastes handled at your facility? All medical <br /> waste generators are required to keep accurate records regarding containment, storage, <br /> hauling, treatment, and disposal. All medical waste records area to be maintained and <br /> available for review during inspection for 3 years. <br /> h- Describe your medical waste emergency action plan, including procedures for handling spills, <br /> exposures, equipment failures, etc. <br /> I hereby certify to the best of my knowledge and belief that the statements made herein are correct and true. <br /> SIGNATURE TITLE DATE <br /> 5 <br />