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MEDICAL WASTIISPECTION REPORT Date: San Joaquin County Environmental Health Department Program 912-0 i 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: T 1n-d H500 OZ (209)468-3420 Program u <fpoa1'� www.siogy.org/ehd Element: 1 .57Z2 Facility Name Address City Zip Code Lodi Memorial Hospital West 800 s. lower sacramento rd. Lodi 94240 Facility Contact Title Phone Number Email Inspection Type Matthew Belaski EVS Manager (209)400-5680 mbelaski@lodihe Routine alth.org The above facility is inspected for compliance with Division 104,Part 14 of California Health and Safety Code(HSC). Registration Treatment ❑ HSC 117890-No LQG shall generate medical waste unless HSC 118130-All onsite medical waste treatment facilities shall 1 registered with the EA. ❑ 17" be permitted by the EA. ❑ HSC 117950-LQG shall register with the EA prior to 2" generating medical waste. ❑ 18. HSC 118165-All treatment records shall be kept for 3 years. ❑ HSC 117903-Permit from the EA is required prior to treating HSC 118215-All medical waste shall be treated pursuant to 3" medical waste. El 19" this section. HSC 117925-SQG that treats medical waste onsite shall HSC 118220-Pathology waste of a human nature shall be ❑ 4" register with the EA. ❑ 20. disposed of by interment,incineration,or an approved alternative. HSC 117900-Shall not haul medical waste unless registered, HSC 118222-Contaminated pathology waste,trace chemo ❑ 5. common carrier,trauma scene practitioner,or exempted ❑ 21. waste,or pharm waste from health care settings shall be treated under the MOT exemption. by incineration or an approved alternative. HSC 117928-Common Storage Facility shall have permit HSC 118225-Sharps waste shall be treated pursuant to this El 6" issured by the EA. ❑ 22" section. ❑ 7 HSC 117890-LQG shall notify EA 72 hours prior to Containment/Storage participating in temporary event. HSC 117895-SQG shall notify EA 72 hours prior to HSC 117630-Biohazard bag shall meet the standards set forth ❑ 8" participating in temporary event. ® 23. in this section. HSC 118275-Medical,biohazardous,sharps,trace chemo, Records/Documentation ❑ 24 pathology,or pharmaceutical waste shall be segregated and contained pursuant to this section. The container shall be properly labeled. ❑ 9. HSC 117935-Registered SQG shall file MWMP with the EA. ❑ 25 HSC 118280- Biohazard bags shall be containerized and stored pursuant to this section. HSC 117943-SQG required to register shall maintain HSC 118285-Sharps waste shall be containerized and stored El 10. 26 treatment and shipping and tracking records for 3 years. ❑ " pursuant to this section. HSC 117945-SQG not required to register shall maintain HSC 118295-Containers shall be washed and decontaminated El 1" information document and transportation records for 3 years. El 27" pursuant to this section. ❑ 12. HSC 117960-LQG shall file MWMP with the EA. ❑ 28 HSC 118305- Reuseable drums or conainters used for medical waste shall not be used for other storage. HSC 117975-LQG shall maintain treatment and shipping and❑ HSC 118307- Intermediate storage area shall be secured and 13. tracking documents for 2 years. El marked with proper signage. Transportation ❑ 30. HSC 118310-Designated accumulation area shall be secured and marked with proper signage. ❑ 14. HSC 117946-MOT exemption requirements for SQG. Other ❑ 15. HSG 117976-MOT exemption requirements for LQG. ❑ 31. ❑ 16. HSC 118032-Pharmaceutical waste hauling exemption. 32. Received by: Print: Matthew Belaski Signature:,, Phone: 209 400-5680 Specialist: Print: Harprit Mattu,Sr RENS Signature: �� Phone:(209)468-3284 Reinspecion on/about: A reinspection fee of$130 per hour may be charged. Page 1 of 2 EH-08/2015