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209 957 7783 <br />GOLDEN LIVING CENTER 10:09:18 a.m <br />a is <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202 <br />(209) 468-3420 <br />MEDICAL WASTE INSPECTION FORM <br />09-19-2012 4/5 <br />Date Y -:,14-j 7 <br />PR L/sbr2/ <br />_ A..,e_ <br />• L k f. ' <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 generation of <br />medical waste. <br />(� <br />_2. HSC Section 117903 -Permit from the <br />e <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 />enforcement agency. <br />r <br />t>✓' <br />CA. iraaoq i <br />° 02` <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 />A= 74 Cil--6rw +Mr. ✓7 <br />facility shall be registered with local enforcement <br />!_ )�. re �� A� �q �r r �R � rvy � L,,,�. (1 ail <br />- C a <br />agency. <br />Procedures <br />®B.HSC Section 117935-SOG MWMP <br />1 <br />_9.HSC Section 117943SQG Shall keep <br />l <br />records for 3 years. <br />_10.HSC Section 117945SOG not required to <br />register shall keep records for 2 years, <br />_11.HSC Section 117960-LQG shall file MWMP <br />fA 1 A t+ <br />with enforcement agency. <br />12.HSC Section 117975 -LOG shall keep <br />records for 3 years. <br />r <br />c� +t r c -n l- nLtr. �rtn r.� <br />Transportation <br />_13. HSC Section 118030-LQHE application. <br />Treatment/Storage <br />ntC. r3Cr� 00 ill, ,rtjr\*� -ic1%4&ZL _rg-� �O%t CA <br />r pyi L n► n r i n rJ.11 61 <br />J[N �a� tr l �.b 4 t 7L► �c �r7 cJt f.✓r�.a t'° a=C <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 -Ali treatment records <br />Th—all be kept for 3 years. <br />& tZ <br />` r <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 />t� <br />\ <br />CAI rky IW I a=irU3 ft.&kj <br />_18.HSC Section 118225 -Treated sharps shall <br />be destroyed or somehow prevent public access. <br />X19.HSC Section 118275 -MW red bags, path, <br />chemo shall be labeled properly. <br />C <br />V1,7 t �1(T� k 1 1 <br />20.HSC Section 118280 -MW label & contain <br />r21.HSC <br />Section 118285 -Sharps label/contain <br />�� [. G. ✓ r� <br />u •— <br />—22.HSC Section 118295 -Proper decon used. <br />_23.HSC Section 118307 -Interim storage labeled <br />24.HSC Section 118310 -Enclosure labeled. <br />�KMHSC Section 118305 -Cannot reuse drums <br />_26.HSC Section 117630 -Approved biohazard <br />ba used. <br />i .27.HSC Section 118275(8)-Pharrn label/store <br />/ <br /><[ 2, <br />•i � ��! � -� �? �� o '�zt' r(� <br />—28.HSC Section 118222 -Incineration Required . <br />29 Other -Describe in narrative. <br />_ <br />I Signature Rticeived B Date <br />Received lime Sep.19. 2012 11:00AM No.11/9 „- A <br />