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SAN JOAQUIN COUNTY 6 Date <br /> �. ENVIRONMENTAL HEALTH DEPARTMENT PR Qk5 <br /> j 1868 East Hazelton Ave., Stockton, CA 95205 <br /> (209)468-3420 <br /> P MEDICAL WASTE INSPECTION FORM <br /> ,F®��. <br /> FacilityName ' Wo ,,r FOW4 ilityAddress ` I 'W- `1~; 5cry4e- AVc <br /> FacilityContact "TON , S�U V7 Title ENS �(�zc iG�i s} Phone# �b�S_ <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 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 /> 0 <br /> waste. <br /> _3.HSC Section 117890-No large LQG shall tt <br /> generate medical waste unless registered with the S'_ �•'c 1 re Cd7 d I 1 <br /> enforcement agency. <br /> _4.HSC Section 117895-SQG that treats med h fX i1 y�� <br /> waste shall register with enforcement agency. <br /> _5.HSC Section 117900-Shall not haul med U h ' i cMD <br /> waste unless registered or obtained LQHE. OLI 14 <br /> _6.HSC Section 117903-Shall not treat med 1` 4fY <br /> waste without permit from enforcement agency. <br /> _7.HSC Section 117908-Common Storage <br /> facility shall be registered with local enforcement iij, d ' WfAe... b-`­ ` -S <br /> agency. <br /> Procedures Wel DL 'al WN i k'$(a I <br /> _8.HSC Section 117935-SQG MWMP S 10 f o <br /> _9.HSC Section 117943-SQG Shall keep <br /> .it (�I� /n�tlt/S_ <br /> records for 3 years. <br /> _10.HSC Section 117945-SQG not required to , <br /> register shall keep records for 2 years. (ti <br /> 11.HSC Section 117960-LQG shall file MWMP <br /> with enforcement agency. ✓ <br /> _12.HSC Section 117975-LQG shall keep <br /> records for 3 years. <br /> Transportation A MA '/\ (a,�O <br /> _13.HSC Section 118030-LQHE application. <br /> Treatment/Storage �,V us U/ <br /> _14.HSC Section 118135-Shall obtain a permit <br /> from the enforcement agency to treat medical t <br /> waste prior to treating the waste. - �tvj L 6 C a n C <br /> _15.HSC Section 11 8765-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 /> _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 /> 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 /> bag used. <br /> 27.HSC Section 118275(g)-Pharm label/store �o <br /> _28.HSC Section 118222-Incineration Required Inspect r Signature Received By Date <br /> 29 Other-Describe in narrative. <br />