HomeMy WebLinkAbouthomegeneratedsharpspoint-of-consolidationapplicationform-acdehMedical Waste Management Program
Alameda County Department of Environmental Health
Solid/Medical Waste Management
1131 Harbor Bay Parkway, Alameda, CA. 94502
Phone: (510)567-6790 Fax: (510) 337-9234
https://deh.acgov.org/index.page
HOME-GENERATED SHARPS POINT OF CONSOLIDATION APPLICATION
California Health and Safety Code, Section 117904
Application Type
□Pharmacy □Clinic □Hospital □ Transfer Station □ Household Hazardous Waste □ City/County Program
□Other (Specify) ________________________________________________
Applicant Point of Consolidation Name
Contact Person
Registered Medical/Hazardous Waste Transporter Name Days of Operation at Point of Consolidation □5 days/week (specify days) ___________________
□□
Provide a short description on type of collection unit and how sharps will be stored at the Point of Consolidation.
_________________________________________________________________________________________________
Photo or additional description attached? Yes □ No □
□ *Please check this box if pick-up from Point of Consolidation is to be more than every seven (7) days. This
document serves as a request and approval for extended storage at the Point of Consolidation.
Applicant Signature
PRINT NAME __________________________________________________________________ TITLE __________________________________
SIGNATURE _______________________________________________________________________ DATE __________________________________
NOTE:
•All sharps wastes shall be placed in approved sharps container. Sharps container ready for disposal shall not be held for morethan seven (7) days without the written approval of the enforcement agency. (California Health and Safety Code, Section117904)
•For more information, see the Medical Waste Management Act (California Health and Safety Code, Section 117600, et seq.)including for Home-Generated Sharps Consolidation Points in Sections 117904 and 118147.
•If you are a registered medical waste generator, the Medical Waste Management Act, Section 118147, provides a mechanism
for your facility to accept home-generated sharps. Please contact your Local Enforcement Agency for more information.
•Upon completion, mail, email or fax this form to: Alameda County Department of Environmental HealthOffice of Solid/Medical Waste Management 1131 Harbor Bay Pkwy., Alameda, CA 94502
FOR DEPARTMENT USE ONLY
______________________________________________
ACDEH
Pick-up Frequency _________days
NOTE: Regulations require pick-up once every seven (7) days.*
SEPTEMBER 2018