Hospitals Wastewater Pollution Prevention Plan Template ... · Hospitals Wastewater Pollution Prevention Plan Template – Guidance Document Page 4 of 24 25895547 3. (A) Existing

25895547 _____________________________________________________________________________________________________

4730 Kingsway, Burnaby, BC, Canada V5H 0C6 │ 604-432-6200 Metro Vancouver Regional District │ Greater Vancouver Water District │ Greater Vancouver Sewerage and Drainage District │ Metro Housing Corporation

Hospitals Wastewater Pollution Prevention Plan Template – Guidance Document

Overview This guidance document has been developed to assist hospital staff in completing the required Pollution Prevention Plan (the “Plan”). Information on what is required in each section of the Plan is provided, together with relevant definitions (Appendix A), an example of detailed actions necessary to meet the requirements of the pollution prevention plan regulation (Appendix B), and relevant prohibitions and restrictions from the Sewer Use Bylaw (Appendix C).

Who completes the Plan? The Plan must be signed off by an authorized person from the hospital with overall responsibility for submitting and implementing the Plan. This person should have the necessary budgetary authority and seniority to ensure the relevant actions will be implemented and could include: Executive, Director, Senior Director, Vice President or Chief Operating Officer. Each section should be completed by a qualified professional for the specific area of operations. The qualified professional can be internal hospital staff or a hired consultant. Each section requires contact information for the relevant qualified professional. Note that the same person can author the same sections for multiple hospitals and/or multiple sections in the same Plan.

What information is required? Each section of the template asks questions related to relevant issues. If the responses to the questions require actions to be taken to avoid, minimize or prevent the disposal any contaminant highlighted in the Plan, the hospital is required to do the following:

Review the issue(s) as they understand them to be;

Describe the chosen action to address the issue(s);

Develop a reasonable timeline for implementing the chosen action (this may include budgetary considerations); and

Include milestones with a final completion date.

Who will review the completed Plan? The completed Plan will be reviewed by either Metro Vancouver or City of Vancouver regulatory staff (based on the location of the hospital). If deemed acceptable, the Plan will be approved and the hospital will be expected to implement the Plan as submitted. Annual updates on progress are required.

Hospitals Wastewater Pollution Prevention Plan Template – Guidance Document Page 2 of 24

25895547

How will the Plan be enforced? Regulatory staff may conduct site visits to ensure accuracy of the submissions and/or the progress made to implement the proposed actions in the Plan.

1. Hospital Information Guidance:

- The definition for ‘hospital’ can be found in Appendix A of this document - This section contains:

o Hospital information including address and Health Authority; and o Contact information for the individual with overall responsibility for submitting

and implementing the Plan.

Hospital Name Address

Health Authority

Name (First, Last) *Authorized Person responsible for the P2 Plan

Position Title

Contact Telephone Number Contact Email


25895547

2. Management Policy Statement Guidance:

- This section contains: o Management statement that illustrates the hospital’s commitment to completing

and implementing the Plan.

Management Policy Statement on Pollution Prevention (required) A sample management policy statement is provided below. The sample policy can be adopted as is or it can be modified. The institution can also develop its own Management Policy Statement.

SAMPLE MANAGEMENT POLICY STATEMENT1

[Hospital Name] is part of a health care community dedicated to excellence in the care of our patients and as a steward to the environment. This dedication to excellence is demonstrated in a manner that minimizes undue risk and adverse environmental impacts on human health and the natural environment. We commit ourselves to developing and adopting sustainable best practices and processes in all operations and departments. Priority will be given to identifying ways to minimize the consumption of non-renewable energy and water, as well as the generation of solid, organic, and hazardous waste products. In doing so our institution will at a minimum comply with, or when possible exceed all legal requirements through the application of sustainable development practices. We will reduce and or eliminate the discharge of contaminants, where possible through development of a pollution prevention plan. Whenever possible we will reuse and recycle materials in an environmentally responsible manner. Where it is not possible to reuse or recycle materials, we will ensure that the materials are disposed of in a manner compliant with all relevant laws. We commit to engaging with the healthcare community in a collaborative approach towards environmental, economic, social and ecological sustainability. OR Enter Alternative Management Policy Statement below:

1 Adapted from City of Toronto Pollution Prevention Plan Template and Health Authority Sustainability Policy


25895547

3. (A) Existing Requirements: Biomedical Waste Guidance:

- The definition for Biomedical Waste can be found in Appendix A of this document - This section contains specific questions about:

o The generation of Biomedical Waste within the hospital, o The current handling and disposal of Biomedical Waste, and o If relevant; the actions proposed to ensure Biomedical Waste is no longer

disposed to sewer.

Contact Information (Qualified Professional)

Name of staff or consultant completing this section Position Title


If this section is completed by a consultant, enter the name of the firm.

3. (A) Biomedical Waste The GVS&DD Sewer Use Bylaw No. 299, 2017 (the “Sewer Use Bylaw”) prohibits the discharge of ‘Biomedical Waste’, as defined in the provincial Hazardous Waste Regulation, to sanitary sewer.

1. Does your hospital generate Biomedical Waste?

Yes No

2. If ‘Yes’, what specific Biomedical Waste(s) is generated and what areas of the hospital are the Biomedical Wastes generated?

List types of Biomedical Waste generated. a) ________________________________________ b) ________________________________________ c) _______________________________________

List areas of the Hospital where it is generated. a) _______________________________________ b) _______________________________________ c) _______________________________________


25895547

For each area of the hospital identified above, describe your institution’s current practice(s) for the avoiding, minimizing, or preventing the generation of Biomedical Waste.

3. Does your hospital dispose of Biomedical Waste to the sanitary sewer?

Yes No

Action Plan: If ‘yes’, describe the proposed pollution prevention measures (processes, practices, devices, products, or other methods or actions) that your hospital proposes to take to avoid, minimize, or prevent the disposal of Biomedical Waste to the sanitary sewer.

The details provided must include a statement of objectives, a problem statement (your current understanding of operational issues which may be contributing to the disposal of Biomedical Waste into the sanitary sewer), a description of the actions your hospital proposes to take to meet the objectives, and a schedule of dates for achievement of actions which will result in the avoidance or prevention of the disposal of Biomedical Waste into the sanitary sewer.

Statement of Objectives (optional): Problem Statement (optional): Description of Actions: Schedule to Achieve Actions:


25895547

3 (B) Existing Requirements: Fats, Oils and Grease Management Guidance:

- This section contains specific questions on: o The generation of fats, oils and grease within the hospital; o Whether all grease-bearing fixtures are connected to a grease interceptor; o Whether the current grease interceptor is able to handle the flows from all the

grease-bearing fixtures; and o If relevant, the actions proposed to address issues arising from this review.




Name of additional staff or consultant completing this section

Position Title



3. (B) Fats, Oils & Grease Management The GVS&DD Food Sector Grease Interceptor Bylaw No. 268, 2012 (Grease Interceptor Bylaw) regulates wastewater discharged from commercial kitchens not operating under a Liquid Waste Discharge Permit. The Grease Interceptor Bylaw specifies requirements for discharge limits from grease interceptors, minimum standards for grease interceptors, cleaning and maintenance, and minimum fines for contraventions.

1. Is food prepared, packaged, served, sold, or otherwise handled in a manner that results in the generation of fats, oils and grease within your hospital? This includes those operations run by the hospital and/or a third-party contractor.

Yes No


25895547

2. If ‘Yes’, list the locations where fats, oils and grease are generated.

List here: a)

b)

c)

3. Are all grease-bearing fixtures connected to a grease interceptor?

(Review section 11 of Grease Interceptor Bylaw for all required fixtures.)

Yes No

4. For each area of the hospital identified in #2, list the fixtures that are not connected to a grease interceptor.

5. Is the total flow capacity of the all fixtures that are plumbed to the grease interceptor less than or equal to the maximum rated flow capacity of the grease interceptor?

Review Grease Interceptor Sizing Methodology) Grease Interceptor Sizing Tool

Yes No

6. Do the food preparation areas of your hospitals employ food grinders, potato peelers and other similar equipment used in the preparation of food containing fats, oils and grease?

Yes No

7. If ‘Yes’, are the food grinders, potato peelers and other similar equipment used in the preparation of food connected to a solids interceptor that is connected to a grease interceptor?

Yes No

http://www.metrovancouver.org/boards/Bylaws1/GVSDD_Bylaw_268.pdf

http://www.metrovancouver.org/boards/Bylaws1/GVSDD_Bylaw_268.pdf

http://www.metrovancouver.org/services/Permits-regulations-enforcement/PermitRegulationEnforcementPublications/Approved_Grease_Interceptor_Sizing_Methodology.pdf

http://www.metrovancouver.org/services/Permits-regulations-enforcement/PermitRegulationEnforcementPublications/Approved_Grease_Interceptor_Sizing_Methodology.pdf

http://www.metrovancouver.org/Includes/grease/index.html


25895547

Action Plan: If ‘No’ to questions 3, 5 or 7, describe the proposed actions your hospital will take to deal with the issues noted in the review above.

The details provided must include a statement of objectives, a problem statement (your current understanding of operational issues which may be contributing to the identified issue), a description of the actions your Hospital proposes to take to meet the objectives, and a schedule of dates for achievement of actions which will result in the avoidance or prevention of the disposal of fats, oils and grease into the sanitary sewer.



25895547

3. (C) Existing Requirements: Photographic Imaging Operations Guidance:

- This section contains questions on: o The generation of ‘silver-rich solutions’ in the processing of diagnostic images

including X-rays; o The current handling and disposal of ‘silver-rich solutions’; and o If relevant; the actions proposed to address any issues arising from this review.





3. (C) Code of Practice for Photographic Imaging Operations The Code of Practice for Photographic Imaging Operations in the Sewer Use Bylaw sets out the requirements for managing Non‐Domestic Waste discharged directly or indirectly from a photographic imaging operation into a sewer or a sewage facility.

1. Does your hospital generate a ‘silver-rich solution’ in the processing of creating medical images such as X-Rays?

(These solutions include, but are not limited to: fix and bleach‐fix solutions; stabilizers; low replenished (low-flow) washes; and all functionally‐similar solutions.

Yes No

If ‘Yes’, describe your hospital’s current practice(s) for the avoidance, minimization or prevention of silver-rich waste.

2. Does your hospital dispose of ‘silver-rich solutions’ to the sanitary sewer?

Yes No


25895547

3. If ‘Yes’, does your hospital employ the use of prescribed silver recovery technologies to treat ‘silver-rich solutions’ prior to discharge to sanitary sewer?

Yes No If YES, provide details:

Action Plan: If ‘No’ to question #2 above, describe the proposed measures for pollution prevention (processes, practices, devices, products or other methods or actions) that your hospital proposes to take to avoid, minimize or prevent the disposal of silver-rich solutions to sanitary sewer.

The details provided must include a statement of objectives, a problem statement (your current understanding of operational issues which may be contributing to the identified issue), a description of the actions your hospital proposes to take to meet the objectives, and a schedule of dates for achievement of actions which will result in the avoidance or prevention of the disposal of silver-rich solutions to the sanitary sewer.



25895547

4. (A) Pollutants of Concern: Unused Drug/Pharmaceutical Management Guidance:

- The definition for ‘drugs’ can be found in Appendix A. - This section contains specific questions on:

o The current handling and disposal of unused drugs; and o If relevant; the actions proposed to ensure unused drugs are no longer disposed

to sewer.





4. (A) Unused Drug/Pharmaceutical Management Drugs and other pharmaceuticals may not be fully removed at the region’s wastewater treatment plants and can end up in the environment. The pollution prevention planning regulation requires the elimination of unused drugs, as defined in the provincial Pharmacy Operations and Drug Scheduling Act and includes unused drugs in both a solid and liquid form as listed in the Drug Scheduling Regulation, from disposal to the sanitary sewer.

1. Describe your hospital’s current practice(s) for the management of unused drugs.

2. Does your hospital dispose of drugs to the sanitary sewer?

Yes No

Action Plan: If ‘Yes’ to question #2 above, describe the proposed option for pollution prevention measures (processes, practices, devices, products or other methods or actions) that your hospital proposes to take to avoid, minimize or prevent the disposal of drugs to sanitary sewer.


25895547

Action Plan cont.

The details provided must include a statement of objectives, a problem statement (your current understanding of operational issues which may be contributing to the identified issue), a description of the actions your hospital proposes to take to meet the objectives, and a schedule of dates for achievement of actions which will result in the avoidance or prevention of the disposal of unused drugs to the sanitary sewer.



25895547

4 (B) Pollutants of Concern: Formalin Management Guidance:

- This section contains specific questions on: o The current handling and disposal of formalin; and o If relevant; the actions proposed to restrict the concentration of formaldehyde to

sewer to a maximum concentration of 30 mg/L. - The specific actions could include neutralizing formalin prior to discharge to sewer or

contracting a third-party chemical management company to properly dispose of the waste.





4. (B) Formalin Management Formaldehyde, the main chemical ingredient in formalin, is listed by the US Occupational Safety and Health Administration (OSHA) as a carcinogen and the Province of BC’s health and safety policy recommends managing exposure of workers to formaldehyde. Metro Vancouver is restricting the disposal of formaldehyde to the sanitary sewer to a maximum concentration of 30 mg/L.

Does your hospital use formalin? Yes No

1. Describe your hospital’s current practice(s) for the management of waste formalin.

2. Does your hospital dispose of formalin to the sanitary sewer?

Yes No


25895547

Action Plan: If you answered ‘Yes’ to question #2 above, describe the proposed option for pollution prevention measures (processes, practices, devices, products or other methods or actions) that your hospital proposes to take to avoid, minimize, prevent, or restrict the disposal of formalin (formaldehyde) to the sanitary sewer to 30 mg/L. The details provided must include a statement of objectives, a problem statement (your current understanding of operational issues which may be contributing to the identified issues), a description of actions your hospital proposes to meet the objectives, and a schedule of dates for achievement of actions which will result in meeting the 30 mg/L restriction for disposal of formaldehyde to sanitary sewer. Statement of Objectives (optional): Problem Statement (optional): Description of Actions: Schedule to Achieve Actions:


25895547

5. Continuous Improvement Guidance:

- This section focuses on continuous improvements with respect to wastewater quantity and quality in each area of the hospital listed below. Examples of practices to be reviewed include but are not limited to:

o The presence of corrosion inhibitors containing molybdate in heating/cooling systems;

o Micro-scaling of lab analyses; o The storage of chemicals and ensuring adequate containment or practices to

mitigate spills from entering the sewer; o Chemicals used and investigating less toxic alternatives; o Implementing practices to minimize grease entering the sewer; o The use of macerators in wards (source of significant solids in the wastewater

discharge); and o The use and disposal of wipes in the wards. o The elimination of once-through cooling water

This section is to review other existing practices in order to develop detailed plans and timelines, where applicable, to avoid or minimize the creation of pollutants and waste and reduce the overall risk to human health or the environment in the following areas of the Hospital:

Acute Care Wards Ambulatory Outpatient Unit Building Services Diagnostic Imaging

Diagnostic Laboratory Food Services Housekeeping Morgue

Pharmacy Surgery Other

Complete all relevant sections for different areas of the hospital. Copy this page and use for each area.


Name of staff completing this section Position Title


Review the sources of wastewater in each area of the hospital and propose ways to minimize the pollutants and waste to reduce the overall risk to human health or the environment.

http://www.metrovancouver.org/services/Permits-regulations-enforcement/PermitRegulationEnforcementPublications/Grease10Tips.pdf


25895547

Action Plan: Describe the proposed actions that your hospital will take to minimize the discharge of the identified pollutants.

The details provided must include a statement of objectives, a problem statement (your current understanding of operational issues which may be contributing to the identified issues), a description of the actions your hospital proposes to take to meet the objectives, and a schedule of dates for achievement of these actions.



25895547

6. Declaration Guidance This section is for the signature of the Senior Official named in the Section 1 “Hospital Information” of this Plan, responsible for the overall development and implementation of the Plan.

6. Declaration

As an Authorized Person at this facility, I [insert name] declare that this Plan and all information and

supporting documentation contained in this Plan are accurate and complete to the best of my

knowledge. I agree to oversee compliance with this Plan and make it readily available for inspection at

the subject premises by representatives from Metro Vancouver or the City of Vancouver.

Signature

Date (yyyy-mm-dd)


25895547

Appendix A

Definitions

Biomedical Waste

The provincial Hazardous Waste Regulation defines biomedical wastes in part as:

human blood and blood products, consisting of

(i) human fluid blood and blood products,

(ii) items saturated or dripping with human blood,

(iii) body fluids contaminated with human blood, and

(iv) human body fluids removed for diagnosis or during surgery, treatment or autopsy

Drug

The Pharmacy Operations and Drug Scheduling Act defines drug as follows:

"drug" means a substance or combination of substances used, or for use, in or on the body of a

person or animal

a) to prevent, diagnose, treat or mitigate a disease, disorder or abnormal physical or mental

state or a symptom of them; or

b) to restore, correct or modify organic functions.

The list of affected drugs are included in the Schedules of the Drug Schedules Regulation of the

Pharmacy Operations and Drug Scheduling Act.

Hospital

For the purposes of this regulation, we are focusing on hospitals as defined in section 1 (a) of the provincial

Hospital Act.

"hospital", except in Parts 2 and 2.1, means a non-profit institution that has been designated as a

hospital by the minister and is operated primarily for the reception and treatment of persons

a) suffering from the acute phase of illness or disability,

and does not include the following:

1. A private hospital as defined in Part 2 of the Hospital Act (nursing or convalescing home);

2. A designated hospital operated for the treatment of patients convalescing from or being

rehabilitated after acute illness or injury; or

3. A designated hospital operated for the treatment of patients requiring extended care at a

higher level than that generally provided in a private hospital.

http://www.bclaws.ca/Recon/document/ID/freeside/63_88_01#section1

http://www.bclaws.ca/civix/document/id/complete/statreg/03077_01

http://www.bclaws.ca/civix/document/id/complete/statreg/9_98

http://www.bclaws.ca/civix/document/id/complete/statreg/96200_01#section1


25895547

It is our interpretation that the following institutions are defined as hospitals and are included in this

regulation:

Vancouver Coastal Health Fraser Health

Lions Gate Hospital

Richmond Hospital

UBC Health Sciences Centre Hospital

Vancouver General Hospital

Burnaby Hospital

Delta Hospital

Eagle Ridge Hospital & Health Care Centre

Jim Pattison Outpatient Care & Surgery Centre

Langley Memorial Hospital

Peace Arch District Hospital

Ridge Meadows Hospital & Health Care Centre

Royal Columbian Hospital

Surrey Memorial Hospital

Providence Health Care Provincial Health Services Authority

Mount Saint Joseph Hospital

St. Paul's Hospital

B.C. Cancer Agency – Vancouver

B.C. Cancer Agency – Surrey

British Columbia's Children's Hospital & B.C. Women's Hospital & Health Care Centre


25895547

Appendix B

This Appendix provides an example of a proposed action plan for hospital staff to implement to manage

issues identified in each section. For this example, the requirement to meet a discharge limit of 30mg/l

for formaldehyde (Section 4B of template).

Action Plan Example – Meeting Discharge Limit for Formaldehyde

Statement of Objectives (optional)

[Hospital Name] is committed to restrict the disposal of formaldehyde, a major ingredient in formalin, to

the sanitary sewer by July 1, 2020. Formaldehyde is used primarily as a tissue preservative but also has

disinfectant properties. As a tissue preservative it can be found in histology labs where tissues are

sectioned and prepared for microscopic analysis. Formaldehyde bearing wastes are generated in multiple

areas of the hospital and the proposed Action Plan will be implemented in all areas simultaneously.

Problem Statement (optional)

Formaldehyde bearing wastes is generated in a number of areas in the hospital including the Histology

Lab and the morgue. Minimal amounts of formalin are discharged to the sewer during the preparation of

the histology sample. However, once the sample is no longer required, the tissue is separated into the

designated anatomical waste containers and the remaining formalin solution is disposed of down the

drain.

Action Plan

[Hospital Name] is committed to the following Action Plan:

Q2 2019 Review suppliers for formaldehyde neutralization chemicals

Review third-party chemical waste management companies for off-site disposal

Q3 2019 Determine preferred approach and submit relevant budget request

(Assume neutralization chemicals is chosen)

Q4 2019 Develop training for relevant staff regarding the proper use and storage of the

neutralizing agents

Q1 2020 Implement proposed new procedures to neutralize formalin

Q2 2020 Review effectiveness of new procedures to neutralize formalin

Note: This example illustrates an action plan that will be implemented simultaneously throughout

the hospital. However, if there are separate actions required for each area, a detailed Action Plan

for each area of the hospital is required.


25895547

Appendix C

This Appendix outlines applicable sections of GVS&DD Sewer Use Bylaw No. 299, 2007 relevant to

Hospitals.

Prohibited Wastes The following are designated as Prohibited Wastes: Waste Causing Obstruction or Interference Any Waste which is capable of obstructing the flow of or interfering with the operation or performance of any Sewer or Sewage Facility including, but not limited to earth, sand, ash, glass, tar, asphalt, plastic, wood, waste portions of animals, fish or fowl, and solidified fat. Radioactive Waste (Nuclear Substances) Waste radioactive substances in excess of quantities or concentrations specified for release to the environment under the Nuclear Safety and Control Act and Regulations or amended versions thereof, or under a licence issued in accordance with s. 24(1) of the Nuclear Safety and Control Act. Biomedical Waste Any Waste that, at the point of discharge into a sewer, contains Biomedical Waste as defined in the Hazardous Waste Regulation as amended from time to time pursuant to the Environmental Management Act. Hazardous Waste Any waste defined as Hazardous Waste in the Environmental Management Act with the exception of Hazardous Waste in compliance with the effluent standards contained in Schedule 1.2, Column 3 of the Hazardous Waste Regulation.

http://www.metrovancouver.org/boards/Bylaws1/GVSDD_Bylaw_299-Unofficial_Consolidation.pdf


25895547

Restricted Wastes Restricted Waste means any of the following: Particle Size Waste Any Non‐Domestic Waste, including that from cooking and handling of food that at the point of discharge into a Sewer, contains particles larger than 0.5 centimetres in any dimension. pH Waste Any Non‐Domestic Waste which, at the point of discharge into a Sewer, has a pH lower than 5.5 or higher than 10.5. Specified Waste Any Wastewater which, at the point of discharge into a Sewer, contains any substance with a concentration in excess of the levels set out in Tables (A), (B) or (C) below. All concentrations are expressed as total concentrations, which include all forms of the contaminant, combined or uncombined, whether dissolved or undissolved obtained from a Grab Sample. Definitions and methods of analysis for these substances are outlined in Standard Methods or methods specified by a Sewage Control Manager.

Table A – Conventional Contaminants

Contaminant Maximum Concentration

(mg/L)

Biochemical Oxygen Demand (BOD) 500

Total Suspended Solids (TSS) 600

Total Oil and Grease 1 (O&G – Total) 150

Oil and Grease (Hydrocarbon) (O&G – Hydrocarbon

15

Note: 1 Total Oil and Grease includes Oil and Grease (Hydrocarbons)

Table B – Organic Contaminants


(mg/L)

Phenols 1.0

Chlorophenols1 0.05

Polycyclic Aromatic Hydrocarbons2 (PAHs) 0.05

Benzene 0.1

Total BETX3 1.0

Tetrachloroethylene 0.05

Note: 1 Chlorophenols include:

tetrachlorophenols (2,3,4,5‐, 2,3,4,6‐, 2,3,5,6‐) pentachlorphenol


25895547

2Polycyclic Aromatic Hydrocarbons (PAHs) include: acenapthene chrysene acenaphthylene dibenzo(a,h)anthracene anthracene fluoranthene benzo(a)anthracene fluorene benzo(b)fluoranthene naphthalene benzo(k)fluoranthene phenanthrene benzo(g,h,i)perylene pyrene benzo(a)pyrene indeno(1,2,3‐c,d)pyrene

3BETX include: benzene ethylbenzene toluene xylenes

Table C ‐ Inorganic Contaminants


(mg/L)

Metals

Aluminum 50.0

Arsenic 1.0

Boron 50.0

Cadmium 0.20

Chromium 4.0

Cobalt 5.0

Copper 2.0

Iron 10.0

Lead 1.0

Manganese 5.0

Mercury 0.05

Molybdenum 1.0

Nickel 2.0

Selenium 1.0

Silver 1.0

Zinc 3.0

Other Inorganic Contaminants

Cyanide 1.0

Sulphide 1.0

Sulphate 1500

Waste Causing Interference or Injury Any Waste in a concentration or quantity which may interfere with the proper operation of a Sewer or Sewage Facility or which may injure or is capable of injuring the health of any person, property, or life form.


25895547

Water for the Purpose of Diluting Subject to section 5.2, no person shall discharge or allow or cause the discharge into a Sewer or a Sewage Facility any of the following:

g) water or any substance for the purpose of diluting any Non‐Domestic Waste.

Documents

Hospitals Wastewater Pollution Prevention Plan Template ... · Hospitals Wastewater Pollution Prevention Plan Template – Guidance Document Page 4 of 24 25895547 3. (A) Existing