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11 <br />GUIDELINES FOR THE MEDICAL WASTE MANAGEMENT <br />PLAN <br />Small quantity generators that provide Onsite Treatment and all large quantity generators <br />shall have a Medical Waste Management plan on file with the San Joaquin County <br />Environmental Health Department. The Medical Waste Management Plan shall contain the <br />following information as appropriate for your facility: <br />Business Name�5after kluld � ddt R)ijndA UVl <br />Business Address: U'Ju) fto&tal Nza - �� kl- I±ll'nl'1'1P_Y U-) <br />City State Zip Code <br />Phone Number: (p�U'"t ) JL-1� ` --n `T <br />Type of Facility or Business: <br />REGISTRATION FOR: <br />❑ Small Quantity Generator with Onsite Treatment (Generates less than 200lbs/month). <br />XLarge 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 Waste Management Plan: <br />V y <br />Name: i� �� Title:t?:-t� �►'�(y�1ta(Z l� <br />Phone:) e�7--Drb),- ��� �jc;� , t�Z L Date: I i I <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 specimens, trace chemo or isolation wastes": <br />��R,P.S: us�a/..i�r N�c.�s �r2�N�„s w/w•6 �,� , �uB ��6 u;/n_ �� f SvT�,� <br />r{ o 0 S <br />b) <br />X Yes ❑ No <br />waste (expired/outdated, spent, partials,)? <br />If yes, describe the type of pharmaceutical waste (expired; spent, partials, outdated, patient <br />returns, etc): <br />fAs,- #A- — DRUG VIav t uSrD ljoJecTAr P-5 MCDrut i o.J SM/R��GES <br />And estimate the monthly amount of pharmaceutical waste generated at your <br />facility: <br />EHD 45-03 5 <br />10/6/2006 <br />