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1 <br />SAN JOAQUIN COUNTY <br />Environmental Health Department DIRECTOR <br />pQU �y Linda Turkatte, RENS <br />1868 E. Hazelton Avenue <br />Stockton, California 95205 PR RGobRAriMMCOO1RoDltJ ET�QRS <br />Jeff Carruesco, RENS, RD[ <br />Website: www.sicehd.com Kasey Foley, RENS <br />°�fPair� <br />Phone: (209) 468-3420 Adrienne Ellsaesser, RENS <br />Fax: (209) 468-8392 Rodney Estrada, REHS <br />INFORMATION PACKET FOR MEDICAL WASTE GENERATORS <br />This packet contains the information and forms you will need to help you comply with the <br />Medical Waste Management Act. <br />Instructions <br />Please return the completed forms prior to medical waste generation or treatment. <br />1. Complete the "Pre -Application Questionnaire" on Page 2. If your answers indicate <br />you are not required to register as a medical waste generator, then complete the <br />"Certification Statement" on Page 3 and return both complete forms to the mailing <br />address below. <br />2. If you are required to register as a medical waste generator, as indicated by affirmative <br />answers to questions 3 & 4 on the "Pre -Application Questionnaire", then: <br />a. Complete the "Registration for Medical Waste" form located on Page 4. <br />b. Complete a "Medical Waste Management Plan" following the guidelines <br />provided on Page 5. <br />c. Return the completed forms and management plan to the mailing address <br />below. <br />Your cooperation in promptly registering and following the specified handling requirements is <br />greatly appreciated. <br />If you have any questions regarding registration or handling requirements, please contact us at <br />(209) 468-3420 and ask for assistance in the Medical Waste Program. <br />RETURN ALL COMPLETED FORMS TO: <br />San Joaquin County Environmental Health Department <br />1868 E. Hazelton Ave. <br />Stockton, CA 95205 <br />Attn: Medical Waste Program <br />EHD 45-03 1 <br />2015 <br />