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SAN JOAQUIN COUNTY Date <br /> ENVIRONMENTAL HEALTH DEPARTMENT PR 0� 56109 <br /> 1868 East Hazelton Ave., Stockton, CA 95205 <br /> (209)468-3420 <br /> MEDICAL WASTE INSPECTION FORM <br /> FacilityName FozknjiJiv--\- (�)M-Aeu- FacilityAddress IM IN- 'V-b5P, Lik AV <br /> '01) <br /> FacilityContact7o,)ICN- �0(lw Title C-)3-S 5mcials!'A Phone# gas -1899 <br /> INSPECTION TYPE: .Routine ElComplaint olte-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. –Tv)lzrc- a je, ')L*e�' A -4Tit <br /> W <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 in o's <br /> generate medical waste unless registered with the <br /> eni 14 c�v,-w) (,0j*tA I'-rv,,, PiPeA <br /> enforcement agency. 1A <br /> —4.HSC Section 11 7895-SQG that treats med S1 S W),'*LAt <br /> waste shall register with enforcement agency. <br /> —5.HSC Section 117900-Shall not haul med A OL <br /> waste unless registered or obtained LQHE. <br /> —6.HSC Section 117903-Shall not treat med <br /> waste without permit from enforcement agency. frl.'IQ \,00 ej MtAnY4, tffltl� P Ito, <br /> _7 <br /> THSC Section 117908-Common Storage <br /> a ility shall be registered with local enforcement <br /> 16?CA& f&IIC41 ILA <br /> T� <br /> +V, F"yj C&L)-. <br /> agency. <br /> Procedures <br /> 8.HSC Section 117935-SQG MWMP <br /> —9.HSC Section 117943-SQG Shall keep fA1 0 A<-4 <br /> records for 3 years. Q <br /> —10.1-11SC Section 117945-SQG not required to <br /> register shall keep records for 2 years. <br /> 11.HSC Section 117960-LQG shall file MWMP <br /> �with enforcement agency. r iIN T14 m <br /> —12.HSC Section 117975-LQG shall keep -j NJ <br /> records for 3 years. (I A17,11A Q�IVI,6&05 L�'&rel A1\1±t% 14'�Iel <br /> Transportation <br /> —13.HSC Section 118030-LQHE application. <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 /> ;hall 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 /> 211.1-11SC Section 118285-Sharps label1contain <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 /> 0 163 <br /> 27.HSC Section 118275(g)-Pharm label/store <br /> 28.HSC Section 118222-Incineration Requiredjo <br /> InSpe( r Signature Received By Date <br /> 29 Other-Describe in narrative. <br />