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40 so <br /> LIMITED QUANTITY HAULING EXEMPTION (LQHE) <br /> EXAMPLE MEDICAL WASTE LOG SHEET <br /> (Per California Health and Safety Code Section 118030) <br /> To be used by home agencies, private practices, or other professional health care facilities with a Limited Quantity <br /> Hauling Exemption (LQHE) approved by a county or state medical waste management program. No more than <br /> 20 pounds of medical waste may be transported at any time, and only by staff whose names were submitted along <br /> with the LQHE application. Storage of medical waste, except in a designated and/or approved storage area at the <br /> place of generation or consolidation, is not allowed under any circumstance. Completed log sheets must be kept <br /> on-site for at least three years along with tracking documents from the commercial medical waste transporter. <br /> Name of health care agency/private practice Telephone number <br /> l ) <br /> Address(number,street) city State ZIP code <br /> Example: One three gallon sharps ©r. Janes January 03, 2003 JanuaryQ7,'2003 <br /> *Enter one medical waste container per line on this tracking form, as per HSC Section 118030. <br /> Page 4 of 4 <br /> DHS 8664(11/03) <br />