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urK SAN JOAQUIN COUNTY Date '411(d vq <br /> ENVIRONMENTAL HEALTH DEPARTMENT PR OLISQiQ <br /> 1868 East Hazelton Ave., Stockton, CA 95205 <br /> (209)468-3420 <br /> e �iFo �'`� MEDICAL WASTE INSPECTION FORM <br /> FadfityName_L, Ave. <br /> ,,L-s�dFb�tko(A �ff)W*�Pttv- FacilityAddress I"111 W. jp(WAI el <br /> FacilityContact. -coni, I,,- Title 0A.S Soee,,(Ao5E . —Phonek2Vq-12—aS-3-&&S <br /> INSPECTION TYPE: (�Routine EiComplaint EiRe-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 /> �de-nerator shall register with the enforcement <br /> agency prior to commencement of the generation of <br /> medical waste. 00+aA (AJ/)A A)-)), <br /> 2.HSC Section 117903-Permit from the 00 <br /> -en-forcement agency required to treat medical <br /> waste. <br /> —3.HSC Section 117890-No large LQG shall '�)gkg::j V&A CIVA u i5k i�-� ) r cm)NOV oum, (AY)A <br /> generate medical waste unless registered with the L Q tA <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 c�('- l W wae- <br /> waste unless registered or obtained LQHE. <br /> —6.HSC Section 117903-Shall not treat med <br /> waste without permit from enforcement agency. <br /> - <br /> T�7 THSC Section 117908-Common Storage on so'L4t, <br /> facility shall be registered with local enforcement <br /> agency. <br /> Procedures UVCflUI\A Qi&uPl- fU(:\1A'\A <br /> 8.HSG Section 11 7935-SQG MVVMP <br /> 9.HSG Section 117943-SQG Shall keep A <br /> records for 3 years. hbtCAJCOC&SQVIN <br /> —10.HSC Section 117945-SQG not required to <br /> register shall keep records for 2 years. cc, 1 AS <br /> 11.HSC Section 117960-LQG shall file MWMP <br /> with enforcement agency. <br /> —12.HSC Section 117975-LQG shall keep ALL'OjAllyi �p+10aAC-4sA41itht, (LLQ)CAC-"--- <br /> records for 3 years. <br /> Transportation n1nAj'<)hu(A'1� (.A 1)(,t& )s A <br /> —13.HSC Section 11 8030-LQHE application. 'In <br /> Treatment/Storage �Q P J <br /> 14.HSC Section 118135-Shall obtain a pen-nit SA hA ',0[A k A ASA-i 1A c <br /> From the enforcement agency to treat medical <br /> waste prior to treating the waste. io Ln c�� AA(�,- Vi kAXcPa-AA -IR M- mt <br /> --15.HSG Section 118765-All treatment records (,Xx�i t4k LAWASV� " - <br /> shall be kept for 3 years. (2L <br /> 16.HSC Section 11 8215-All medical waste (A (()JA1,-j)P 6kj <br /> shall be treated pursuant to this section. tt <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 118276-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.used. <br /> —27.HSC Section 118275(g)-Pharm label/store <br /> —28.HSC Section 118222-Incineration Required Inspdtor Signature Received By Date <br /> 29 Other-Describe in narrative. <br />