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10/14/2013 18:13 20923949 MANTECARM PAGE 06 <br /> GUIDELINES FOR THE,, MEDICAL 'WASTE MANAGEMENT <br /> PLAN <br /> Small quantity generators that provide Onsite Tteatment and all .large quantity generators <br /> shall have a Medical Waste Management plats on file with the San Joaquin County <br /> Environmental ,[Jealth. Departiment. The Medical Waste Management .Plan -,hall contain the <br /> following information as appropriate for your facility: <br /> II-- 1 f <br /> Business Name: (��fM►1 C.c,C' CCGf Q, ,g �e�l Gt fJ J( <br /> Busin..ess Address: vl 0 e(—a 5000 A/'e <br /> �-� c GA- I <br /> City State Zip Code <br /> Phone .Nurnber: <br /> Type of,'Facility or Business: � �a � �� � �v�@��cw� G�C 1 4 <br /> REGYSTRA,TION FOR: <br /> ❑ Small Quantity Generator with Onsite Treatment(Generates less than 2001bs/month). <br /> Large Quaw:ity Generator Ortly(Generates 200 lbs o.r ntorehn.onth). <br /> ❑ Large Quantity Generator with Onsite Treattment(Generates 200 lbs or morchnonth). <br /> Person responsible.for implementation,ofthe Medical Waste Management Plan: <br /> Name: 1CG��, Title: _ ,✓I_r6� � <br /> Phone: rt`C) �o�2 '�12 2 T Date: 6 <br /> 1. List the types of medical waste gencrated at your facility, i.e., laboratory wastes,blood or body <br /> fluids,sharps,contaminated animals.surgical specimens,trace chemo or isolation,wastes": <br /> a.) Do you generate gny pharmaceutical waste(expired/outdated,spent,partials,)? <br /> b) �.Yes ❑No <br /> If ycs, describe the type of pharmaceutical waste(expired.,spent, partials,outdated,patient <br /> retunis, etc): <br /> And estimate the monthly amount ofpharmaceutical waste generated at your <br /> facility: <br /> E- M 45.03 <br /> Received Time°"Oct, 14. 2013 6. 14PM No. 0850 5 <br />