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aPa'''•^+.,o SAN JOAQUIN COUNTY Date <br /> ENVIRONMENTAL HEALTH DEPARTMENT PR c'15 (nllo <br /> 600 East Main Street, Stockton, CA 95202 <br /> (209)468-3420 <br /> MEDICAL WASTE INSPECTION FORM <br /> FacilityName I Anis CQA niu U ( te,(,rike r FacilityAddress <br /> FacilityContact V�fa®na, (`l1i�l�s Title m;n7sr,u,}®t Phone a W'73- 40 <br /> INSPECTION TYPE: DkRoutine ❑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. 1_ <br /> _2.HSC Section 117903-Permit from the k`' GMK-1. 'ouS <br /> enforcement agency required to treat medical j -3 <br /> waste. t I—�- 1 e <br /> _3.HSC Section 117890-No large LQG shall v a. Jl <br /> generate medical waste unless registered with the n 11 e <br /> enforcement agency. <br /> _4.HSC Section 117895-SQG that treats med s <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 1 e. 5 <br /> waste without permit from enforcement agency. U U <br /> _7.HSC Section 117908-Common Storage ° <br /> facility shall be registered with local enforcement 4&r <br /> agency. <br /> Procedures ' o <br /> —8.HSC Section 117935-SQG MWMP <br /> _9.HSC Section 117943-SQG Shall keep ld S <br /> records for 3 years. c� �, CL <br /> 61-ntA <br /> _10.HSC Section 117945-SQG not required to t <br /> register shall keep records for 2 years. p `j <br /> 11.HSC Section 117960-LQG shall file MWMP <br /> with enforcement agency. <br /> _12.HSC Section 117975-LQG shall keep Z a <br /> records for 3 years. <br /> Transportation <br /> _13.HSC Section 118030-LQHE application. ov i <br /> ul <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 /> shall be kept for 3 years. <br /> 16.HSC Section 11821 5-All medical waste <br /> s-hall 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 r <br /> bag used. A <br /> _27.HSC Section 118275(g)-Pharm label/storeAid <br /> _28.HSC Section 118222-Incineration Required Inspe t r Signature Received B Date <br /> 29 Other-Describe in narrative. <br />