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PqulN SAN JOAQUIN COUNTY Date -7-'9-11 <br /> ENVIRONMENTAL HEALTH DEPARTMENT PR <br /> 600 East Main Street, Stockton, CA 95202 <br /> (209)468-3420 <br /> MEDICAL WASTE INSPECTION FORM <br /> FacilityName.LA kale ztie, FacilityAddress ryl <br /> FacilityConta Title <br /> INSPECTION TYPE: DRoutine oComplaint WjRe-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 /> -denerator 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 /> waste. LA <br /> —3.HSC Section 117890-No large LQG shall e-,-U7'72aq <br /> generate medical waste unless registered with the <br /> 5 L2 <br /> enforcement agency. <br /> —4.HSC Section 11 17895-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 1.11 <br /> �waste without permit from enforcement agency. <br /> THSC Section 117908-Common Storage <br /> ckln <br /> fa—cility shall be registered with local enforcement <br /> agency. <br /> Procedures e. M 4-CAL-11 CA--b Z=A, i_22 11/-4- <br /> -8.HSC Section 117935-SQG MWMP via 12C2 <br /> 9.HSC Section 117943-SQG Shall keep <br /> records for 3 years. -s'LO=S <br /> _10.HSC Section 117945-SQG not requited to im hi e edd L�_ <br /> register shall keep records for 2 years. n <br /> —I 1.HSC Section 11 7960-LQG shall file MWMP bLNCel:,�: Ah <br /> ;With enforcement agency. <br /> —12.HSC Section 117975-LQG shall keep <br /> records for 3 years. <br /> Transportation e- Ld2�?A4 4A Z_- C:12 12S <br /> 13.HSC Section 118030-LQHE application. <br /> Yr-eatment/Storage <br /> 14.HSC Section 118135-Shall obtain a permit im_e'cl' <br /> From the enforcement agency to treat medical <br /> waste prior to treating the waste. Ij on <br /> 15.HSC Section 118765-All treatment records U Z 2 ±Z2 <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 L4 <br /> anatomical parts shall be disposed of by interment <br /> unless otherwise hazardous. 60A 1'yl!�4 DylV1 1-1 74- A 7)LIJ <br /> __18.HSC Section 118225-Treated sharps shall CQ2j f:Z-A <br /> be destroyed or somehow prevent public access. <br /> —19.HSC Section 118275-MW red bags,path, I <br /> chemo shall be labeled properly. U <br /> _X20.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 /> :X25.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 <br /> —28.HSC Section 118222-Incineration Required S 6 *Signature RM61'ni By Date <br /> ature <br /> —29 Other-Describe in narrative. � S 19 r <br />