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Page 9 of 12
<br /> inspection Date: 10/22/2018 Time: 08:40:21 AM
<br /> Name of Inspector: charlene Signature of Inspector:
<br /> Retail Rx*
<br /> *If your
<br /> location has a
<br /> Check All Store Yes Pharmacy,you
<br /> a � Store Number: 3908
<br /> Operations Inspected:
<br /> must inspect
<br /> the Pharmacy
<br /> N/A ❑ F, tote(s).
<br /> #of totes inspected: 1 1
<br /> Retail Store Log
<br /> Are all bags storing hazardous waste X
<br /> completely sealed?
<br /> Are all totes in GOOD condition(NOT broken,
<br /> leaking or otherwise in poor condition),including X
<br /> the condition of the cover and handles?
<br /> Do all totes containing waste have a Hazardous
<br /> or Universal Waste label affixed to them?(AF, X
<br /> OX,CA,CB,TX,UW or ToxicRx)
<br /> Has the store address been written on all X
<br /> labels?
<br /> Has the accumulation start date been written on
<br /> all labels for totes containing waste and are all X
<br /> dates less than 90 days**from today's date?
<br /> Has the proper physical state been checked on X
<br /> all labels?
<br /> Have the proper checkboxes been checked on
<br /> all labels to reflect the types of product placed in X
<br /> each tote?
<br /> Are all labels visible for inspection? X
<br /> Is there enough aisle space(36")to allow
<br /> inspections of and access to each tote in the X
<br /> event of an emergency?
<br /> Is the tote free of unidentified waste,leaks and X
<br /> spills?
<br /> Are leaking hazardous waste items being
<br /> properly bagged and labeled,using absorbent X
<br /> and double-bagged where applicable?
<br /> Are hazardous waste items collected in the
<br /> correct tote so different categories of waste X
<br /> items are separate?
<br /> Are damages/returns being processed daily and X
<br /> moved to a tote if hazardous waste?
<br /> Is the store's EPP Summary Poster completed,
<br /> current(with present Store Manager),and
<br /> posted next to out-dialing telephones(in the X
<br /> break room,at out-dialing phones near
<br /> hazardous waste storage areas,and in front
<br /> office)?
<br /> Are spill clean up supplies,including personal
<br /> protective equipment(gloves,goggles,etc) X
<br /> available and in good condition?
<br /> For California Only.Is the store's Hazardous
<br /> Material Business Plan(HMBP)completed, X
<br /> current and available for review?
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