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SAN JMQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 asMain Streetw, CA 95202 <br />(209) 466-3420 <br />yt <br />MEDICAL WASTE INSPECTION FORM <br />FacfiftyNafrle_S-9Y <br />N 'M <br />M�zl Qt 411=1 F:Tnt <br />t <br />Registration <br />1. we Section 11170664x9a Quwft <br />THff—nW 13E[GW REPRESENT VIOLATIONS OF THE CALIFORNIA <br />HEALTH & SAFETY CODE (HSC): <br />agency Vtf2tjg c0MnMM0flt*fft9PMll0n 0 <br />Z HSC fieU. 117903-parm7 from the <br />enfarcernarA agency required to heat medical <br />Waste. <br />— 3.HSC Section 117890 -No large 1QG shall <br />generate mWW waste unless registered wish the <br />frl�A I I k <br />aftmement venty, <br />4. HSC S9otton 19P835vQQ thathoats aged <br />.{— <br />waste shall register With anbvement. agency. <br />6. HSC Swoon 11796D,6hall not bW med <br />waste w9ass registered or obtained WHE <br />- - - ----- ...... ...... ... . <br />—elm Sectors 1IM308H not treat mad <br />—7.Hsc Section Stor4ja <br />facility shall be registered With 1-1 enforcement <br />Procedures <br />Section 1IM6400 MWMP <br />---smad <br />3.Hao section I 1790,SOO Shall keep <br />V <br />records for 2 years. <br />_10.HSC Sootion 1179464QG not required to <br />register shall keep records for 2 years. <br />on 117960-LQG Phalifft MW <br />--JUM Section 1179754I.0G. shall keep <br />records for 3 years <br />Transportoorl <br />HSC Section 118036h QHE application. <br />MCA A-rwa =42h:kal <br />TreatmentiStorage <br />%HSC Section 110136 -Shall obtain a past <br />11 ArAA <br />irWn the enforcement SMCY to VW MdICW <br />f <br />V, I <br />W20 sle. <br />11,213 <br />i slsocclisalcullolnn 111 W1704MI treatment r9=69 <br />—ll <br />be kept for 3 years. <br />Section 51621 M MOdW Waste <br />_j6MC <br />shell be 40aind pursuant io this Swoon. <br />Section 110220-R9monb3ble human <br />—17MG <br />ansimical parts shall be disposed of by intermerd <br />unless olhenswe hazardous, <br />IBMSC Section 118220 -Treated sharps "I <br />destroyed or somebw prevent "I-- access. <br />1q mc section 11 627&M red bags, path, <br />cherno seal be labeled properly. <br />20.HSC Section 1102811-M label & contain <br />211.HSC Saaon 118285 -Sherpa labellcontain <br />— 22.HSC Section 118295 -Proper do= used. <br />23ASC Section 118307 -knelt she labeled <br />:D414SC Section 118310-Embsure 104100, <br />Section 11830SCannot muse dam <br />_25.HSC <br />Section 117530 Approved blobazard <br />___26.MSC <br />bag used. C Section 11827 )-pharm labellstwe <br />* Section $0on 1182224ncineration Required <br />Signature �Xeceived By <br />_28 <br />_20 othir-Describe In narrative. <br />e <br />