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SAN JOAQUIN COUNTYDate 5'o?() -l0 <br />EN MENTAL HEALTH DEPARTME PR X15 <br />600 East Main Street, Stockton, CA 95202 <br />(209) 468-3420 <br />MEDICAL WASTE INSPECTION FORM <br />FacilityName )i COZ�.[ Faci I ityAdd ress fto s - Lr.&el eevJt>1 <br />FacilityContact GA, 4jp i�i© S Titlej' Getuv,Phone#d(`) -- i -7L6?? <br />INSPECTION TYPE: �ftutine ❑Complaint ❑Re -inspection <br />VIOLATION(S) <br />Registration <br />THE ITEMS BELOW REPRESENT VIOLATIONS OF THE CALIFORNIA <br />_ 1. HSC Section 117955 -Large Quantity <br />Generator shall register with the enforcement <br />HEALTH & SAFETY CODE (HSC): <br />agency prior to commencement of the of <br />-generation <br />medical waste. <br />_2. HSC Section 117903 -Permit from the <br />�� �� �, SIS CJCIJ �t COrii'r..MP ✓ <br />G yl l <br />enforcement agency required to treat medical <br />waste. <br />_3. HSC Section 117890 -No large LQG shall <br />generate medical waste unless registered with the <br />y <br />enforcement agency. <br />_4. HSC Section 117895-SQG that treats med <br />waste shall register with enforcement agency. <br />_5. HSC Section 117900 -Shall not haul med <br />waste unless registered or obtained LQHE. <br />_6.HSC Section 117903 -Shall not treat med <br />waste without permit from enforcement agency. <br />_7.HSC Section 117908 -Common Storage <br />t <br />facility shall be registered with local enforcement <br />agency. <br />Procedures <br />_8.HSC Section 117935-SQG MWMP <br />_9. HSC Section 117943-SQG Shall keep <br />records for 3 years. <br />, t <br />r <br />_10.HSC Section 117945-SQG not required to <br />register shall keep records for 2 years. <br />i T <br />11.HSC Section 117960-LQG shall file MWMP <br />with enforcement agency. <br />` <br />Clc Ar�� '�1nI, Gi )IN P� �7 i71 NC.7(`� (r� <br />j <br />l* Yl —)'Y1 P,GtkS— <br />_12.HSC Section 117975-LQG shall keep <br />records for 3 years. <br />Transportation <br />it �, Srvt .✓� t a IVt°r �� _ <br />/ <br />'T VCJ <br />_13. HSC Section 118030-LQHE application.r�� <br />Treatment/Storage <br />_14.HSC Section 118135 -Shall obtain a permit <br />from the enforcement agency to treat medical <br />waste prior to treating the waste. <br />_15.HSC Section 118765 -All treatment records <br />shall be kept for 3 years. <br />_16.HSC Section 118215 -All medical waste <br />shall be treated pursuant to this section. <br />_17.HSC Section 118220 -Recognizable human <br />anatomical parts shall be disposed of by interment <br />unless otherwise hazardous. <br />Ae <br />_18.HSC Section 118225 -Treated sharps shall <br />be destroyed or somehow prevent public access. <br />9.HSC Section 118275 -MW red bags, path, <br />'- <br />chemo shall be labeled properly. <br />_20.HSC Section 118280 -MW label & contain <br />_21.HSC Section 118285 -Sharps label/contain <br />Section 118295 -Proper decon used. <br />�l1PP_n_{`- VIA M SQ-l.✓I. /� h �� ��ti �� f', C� �� <br />_22.HSC <br />_23.HSC Section 118307 -Interim storage labeled <br />e <br />—� t <br />A �! <br />�24.HSC Section 118310 -Enclosure labeled. <br />�✓�, hP_ Pi' i joi;— t� 1�! <br />_25.HSC Section 118305 -Cannot reuse drums <br />_26.HSC Section 117630 -Approved biohazard <br />bag used. <br />27.HSC Section 118275(g)-Pharm label/store <br />—_28.HSC <br />or Signature Receive Date <br />Section 118222 -Incineration Required <br />29 Other -Describe in narrative. <br />