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Po�!!!N SAN JOAQUIN COUNTY Date )1/I1 <br /> a <br /> ENVIRONMENTAL HEALTH DEPARTMEP PR 053WI <br /> 1868 East Hazelton Ave., Stockton, CA 95205 <br /> (209)468-3420 <br /> MEDICAL WASTE INSPECTION FORM <br /> FacilityName Sufi u,4 �_n4� ilityAddress 10700 TnAA (W4u,w�t Flo( <br /> FacilityContact (t, A f)*— Title W tj s,_ M bj-. Phone# aOq)3L3-311 Z 0 <br /> INSPECTION TYPE: outine []Complaint ❑Re-inspection <br /> VIOLATION(S) <br /> Registration THE ITEMS BELOW REPRESENT VIOLATIONS OF THE CALIFORNIA <br /> _1.HSC Section 117955-Large Quantity HEALTH & SAFETY COD (HSC): <br /> Generator shall register with the enforcement <br /> agency prior to commencement of the generation of <br /> medical waste. I I (� 'rL.A),%4 P din .mP <br /> _2.HSC Section 117903-Permit from the <br /> enforcement agency required to treat medical ? _ . Sbt <br /> waste. Z <br /> _3.HSC Section 117890-No large LQG shall Lpn-,i 1 AA 5 <br /> generate medical waste unless registered with the <br /> enforcement agency. <br /> _4.HSC Section 117895 SQG that treats med a, l)7�l 5 sng- r 0 re- +r t rub <br /> waste shall register with enforcement agency. <br /> _5.HSC Section 117900-Shall not haul med rt-v 11 A 0 io A du fc� vn <br /> waste unless registered or obtained LQHE. 1 <br /> _6.HSC Section 117903-Shall not treat med 7HIl�. I 0 <br /> waste without permit from enforcement agency. <br /> _7.HSC Section 117908-Common Storage lt. <br /> facility shall be registered with local enforcement G n ^ J s t 4 <br /> agency. <br /> Procedures On w . Aw1'b+ 6(h6- 2111ups +&f o <br /> _8.HSC Section 117935-SQG MWMP ��, C a <br /> _9.HSC Section 117943-SQG Shall keep <br /> records for 3 years. i ., 44v-, 5 M+ <br /> _10.HSC Section 117945-SQG not required to <br /> aster shall keep records for 2 years. V w GIs(IZ, <br /> 1II MSC Section 117960-LQG shall file MWMP <br /> with enforcement agency. <br /> M12.HSC Section 117975-LQG shall keep <br /> records for 3 years. ® n <br /> Transportation ja 6J;n n a S,' 4k/,k Wn6i, s <br /> _13.HSC Section 118030-LQHE application. t� OA <br /> Treatment/Storage �►tiv`' ' , ` 'lti"S 2 <br /> h <br /> _14.HSC Section 118135-Shall obtain a permit { I 5)'45, C rr,. 0 t &-- 07'from the enforcement agency to treat medical <br /> waste prior to treating the waste. o Lkl i b I n <br /> _15.HSC Section 118765-All treatment records <br /> shall be kept for 3 years. y t L <br /> _16.HSCSection118215-All medical wasteUe- <br /> shall be treated pursuant to this section. L n <br /> _17.HSC Section 118220-Recognizable human nu U(� U l c_cs3 -01(1�5 �Cf' a� OQ of 0 L <br /> anatomical parts shall be disposed of by interment <br /> unless otherwise hazardous. ro V S <br /> _18.HSC Section 118225-Treated sharps shall <br /> bb destroyed or somehow prevent public access. <br /> 19.HSC Section 118275 MW red bags,path, <br /> chemo shall be labeled properly. <br /> _20.HSC Section 118280-MW label&contain <br /> _21.HSC Section 118285-Sharps label/contain <br /> _22.HSC Section 118295-Proper decon used. <br /> _23.HSC Section 118307-Interim storage labeled <br /> _24.HSC Section 118310-Enclosure labeled. <br /> _25.HSC Section 118305-Cannot reuse drums <br /> 26.HSC Section 117630-Approved biohazard <br /> ba_g used. o i <br /> _27.HSC Section 118275(g)-Pharm label/store <br /> _28.HSC Section 118222-Incineration Required Inspe or Signature Received By Date <br /> 29 Other-Describe in narrative. <br />