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Customer ID #: Site ID M <br />• <br />;® Stericycle° Washington, Oregon, Idaho and Alaska Rider <br />I understand that RCRA hazardous waste can not be accepted as medical waste by Stericycle and may not be placed in sharps <br />containers or in medical waste containers (i.e. red bags) at site location(s) listed on agreement. I acknowledge that the following <br />information is accurate and complete regarding RCRA hazardous waste and I have presented this information to the necessary <br />individuals on the staff. In addition, in Washington state only dangerous waste may not be disposed of in regulated medical waste <br />containers. Please refer to the Stericycle Waste Acceptance Protocol to know what is acceptable for RMW containers. <br />RCRA hazardous waste generated by the healthcare industry commonly includes, but is not limited to, the medications listed <br />below. For medications with a "P" code on the table below, empty syringes, ampules, or other containers are considered RCRA <br />waste. For medications with a "U" code on the table below, empty (less than 3% by volume) syringes, ampules, or other containers <br />are not considered RCRA waste. <br />Material <br />Code <br />CASRN <br />Use <br />Trade Name(s) <br />Warfarin>0.3% <br />P00l <br />81-81-2 <br />Blood thinner <br />Couniadin, Jantoven <br />Epinephrine <br />P042 <br />51-43-4 <br />Emergency allergy kits, certain types of glaucoma, eye <br />surgery, cardiac arrest <br />Epipen, Epinephrine <br />Physotigmine Salicylate <br />P188 <br />57-64-7 <br />Acholinergenics (liberates/acts like acetylcholine) <br />Eserine, Physostigmine <br />Physotigmine <br />P204 <br />57-47-6 <br />Acholinergenics (liberates/acts like acetylcholine) <br />Eserine, Physostigmine <br />Mitom cin <br />U010 <br />1404-00-8 <br />Chemotherapy <br />Mitom cin, Mutam cin, Mitosol <br />Acetaldelr de, trichloro <br />U034 <br />302-17-0 <br />Sedative <br />Chloral Hydrate, Somnote, Chloralum, A uachloral <br />C clo hos hamide <br />U058 <br />6055-19-2 <br />Chemotherapy <br />C toxan, Neosar, C clo hos hamide <br />Daunom cin <br />U059 <br />20830-81-3 <br />Chemotherapy <br />Cerubidine, Daunorubicin HCL, Daunoxome <br />Cyclohexane <br />U129 <br />110-82-7 <br />Scabies <br />Lindane, Kwell <br />Mel hahm <br />U150 <br />148-82-3 <br />I Chemotherapy <br />Alkeran, Mel halan <br />Please check only the statements that are applicable to the location(s) in agreement listed above: <br />❑ No RCRA hazardous wastes are generated. <br />❑ This facility dispenses the following <br />medications that, when disposed of, <br />may be considered RCRA waste <br />(check all applicable medications): <br />Print Name: <br />Material. <br />Code <br />Cheelc if dispensed <br />Warfarin>0.3% <br />Po01 <br />Epinephrine <br />P042 <br />Physotigmine <br />Salicylate <br />P188 <br />Physotigmine <br />P204 <br />Mitomycin <br />U010 <br />Acetaldehyde, <br />trichloro <br />U034 <br />Cyclophosphamide <br />U058 <br />Daunomycin <br />U059 <br />Cyclohexane <br />U129 <br />Melphalan <br />U150 <br />All RCRA hazardous wastes generated at this location(s) are properly segregated and disposed of <br />with a licensed waste recycling or disposal service and not included in the medical waste stream. <br />Date: ) , 1 vi <br />Facility Name: KlttltaS County - Jail <br />Signature: a� <br />Phone Number: ( ) Email: <br />Comments: <br />Title: <br />Stericycle respects your privacy and will not distribute your personal information without permission. <br />