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• • <br />SAN JOAQUIN COUNTY Date k( i5I1_ <br />ENVIRONMENTAL HEALTH DEPARTMENT PR btLs000S <br />1868 East Hazelton Ave., Stockton, CA 95205 <br />(209) 468-3420 <br />MEDICAL WASTE INSPECTION FORM <br />Faciliiyae <br />(,cncr4l �Ar,5gLUI <br />FacilityAddress <br />sal, <br />w. <br />q) awl_ <br />FacilityContact <br />e 1 M <br />Title <br />f W0 <br />7� to'' ' 0 J <br />RFU a> )a 'fIG 14,b h In 6a <br />Phone#�'�o1�y.�4_-jp 6 _ <br />I • '111 111111 <br />CI�C9P( 1 <br />Registration <br />THE ITEMS BELOW REPRESENT VIOLATIONS OF THE CALIFORNIA <br />_ 1. HSC Section 117955 -Large Quantity <br />HEALTH & SAFETY CODE (HSC): <br />Generator shall register with the enforcement <br />agency prior to commencement of the generation of <br />medical waste. <br />_2. HSC Section 117903 -Permit from the <br />enforcement agency required to treat medical <br />waste. <br />3. HSC Section 117890 -No large LQG shall <br />f W0 <br />7� to'' ' 0 J <br />RFU a> )a 'fIG 14,b h In 6a <br />generate medical waste unless registered with the <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 />Clc rcro2a_f!� �t t1rc I n-5 te. 8 EWS Dl\ n^ 14�j 00+ <br />L.k W ��CUak i 40f- <br />Ot{ �, c1/AnC# 1 1 11s <br />_6.HSC Section 117903 -Shall not treat med <br />( , i <br />al It&I& S " >� < T rwn,1- j e ,n rS �[V yr In 14 Ga , <br />waste without permit from enforcement agency. <br />_THSC Section 117908 -Common Storage <br />facility shall be registered with local enforcement01 <br />agency. <br />Procedures <br />? " a <br />i <br />' )1ovm s b <br />o S n 1' S ► '1 e' <br />_8.HSC Section 117935-SQG MWMP <br />_9.HSC Section 117943-SQG Shall keep <br />records for 3 years. <br />_10.HSC Section 117945-SQG not required to <br />register shall keep records for 2 years. <br />5 r �S SVS ' <br />vo f I e U a Il it <br />(All <br />11.HSC Section 117960-LQG shall file MWMP <br />with enforcement agency. <br />-7 1 1 <br />Il�,x'al-. �n Te,CU.r`�uj7 `� a,fa I,pl av 17_�G (Yknce,,l. 11a <br />_12.HSC Section 117975-LQG shall keep <br />records for 3years. <br />Transpor$a$ionU]'gUS <br />_13. HSC Section 118030-LQHE application. <br />TreatmentlS$orage <br />_14.HSC Section 118135 -Shall obtain a permit <br />t ,�ir1 Oh�rmtiCaa��i'ca� lnJ1�Z t S�'+fe� <br />1 , <br />W)3-"Ckz <br />UJLA S� 1^ J tr ' <br />from the enforcement agency to treat medical11 <br />waste prior to treating the waste. <br />_15.HSC Section 11 8765 -All treatment records <br />1l� 1 <br />In>tMt,XP ( ®9RT l rlrl' s1 til,n, itT vll atn(1 UT i i7) ILA fyt <br />It 11S tl�- <br />shall be kept for 3 years. <br />9M I <br />_16.HSC Section 118215 -All medical waste <br />shall be treated pursuant to this section. <br />_17.HSC Section 118220 -Recognizable human <br />=12 e e <br />� l <br />anatomical parts shall be disposed of by interment <br />unless otherwise hazardous. <br />_18.HSC Section 118225 -Treated sharps shall <br />be destroyed or somehow prevent public access. <br />19.HSC Section 118275 -MW red bags, path, <br />emo shall be labeled properly. <br />20.HSC Section 118280 -MW label & contain <br />X21.HSC Section 118285 -Sharps labelIcontain <br />_22.HSC Section 118295 -Proper decon used. <br />, b �, �VV 41 01A -0 <br />ihl)tGv�i <br />�� L �fi�, e 70 <br />r �. �� 1 A <br />Co�� y�, (Zp�- ,Mii w1AL—e) (t Oji Ca�1�it�A A 1A `)'1S1tlu <br />�® <br />�tiV�UI2�1L�ct�'C�SfiC�i n �1 ViU1L���wC �� (i(tutnS Cn C�UtUt✓�u�i'hWi��l'��1 <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 />b g used. <br />027.HSC Section 118275(g)-Pharm IabelIstore <br />Instor Signature ReC d By Date <br />P� _ 2 <br />_28.HSC Section 118222 -Incineration Required <br />29 Other -Describe in narrative. <br />