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SAN JO A,QUIN COUNTY <br />1868 E. Hazelton Avenue <br />Stockton, California 95205 <br />Telephone: (209) 468-3420 <br />Fax: (209) 468-8392 <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 Pian shall contain the following information as appropriate for your <br />facility: <br />Business Name: <br />Business Address: <br />Phone Number: <br />Type of Facility or Business: <br />REGISTRATION FOR: <br />❑ SmalI Quantity Generator with Onsite Treatment (Generates less than 200 lbs/month). <br />Large Quantity Generator Only (Generates 200 lbs or more/month). <br />❑ Large Quantity Generator with Onsite Treatment (Generates 200 lbs or more/month). <br />Person responsible for implementation of the Medical aste Management <br />Plan: <br />Name: Title: h)0) 1n,(11 x G(5L*o\/1:5V�1% <br />Phone:rov 61F- 4Date: <br />1. List the types of medical waste generated at your facility (i.e. laboratory wastes, blood or body <br />fluids, sharps, contaminated animals, surgical s.peciinens, tra'{ce chemo or isolation wastes): <br />��... 11_ X41 r7 sN1 Fa 1f%: r�n.ro... �3i a. .. �'4�t'r •niki.7.!"'. i97%'k Vi�N1. 1[��i.n.Pa IL -ILA nn ynt--.- . 1l^�`S'1 <br />a) Do you generate an pharmaceutical waste (expired, spent, partials, patient returns)? Yes ❑ No <br />if yes, describe the type of <br />waste expired, spent, partials, patient returns}: <br />p e e 1 r <br />And estimate the monthly amount of pharmaceutical waste generated at your facility: <br />EHD 45-03 <br />2015 <br />