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oPa"'"SAN JOAQUIN COUNTY Date <br />i NVIRONMENTAL HEALTH DEPART&T PR ,l",.'0, <br />�- -' 600 East Main Street, Stockton,. CA 95202 <br />.t o :` (209) 468-3420 <br />MEDICAL WASTE INSPECTION FORM <br />Facility acne l- nMA.0-Ry, (c,rp_ _ acility d rens Lj), Z. WeAw '6'n 4,A- _ <br />FacilityContact ��`c r�_ .5c f 4 a_ Title L.VS. -fit nA3, ca Phoned <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 />�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 <br />generate medical waste unless registered with the <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 <br />waste unless registered or obtained LQHE. <br />_6.HSC Section 117903 -Shall not treat med <br />waste without permit from enforcement agency. <br />Storage <br />=� ¢ r�\> •' j r 1 <br />•'r7 � ' �' % "' <br />eea {� t <br />6, "•T � Ear• �n i. ,'.' o' i ` .41, ! - <br />n <br />--fes, ty1 �T �1f/ �� ih �t <br />q <br />r •�i'- �', - r'_ �n 'l ;a < hnsi_ t- <br />_ <br />'"� " r'' <br />�� .. (�- N• 1�.j6m. -;`� <br />y <br />t r'}.y1, cc AA r,? a <br />l.r}la. C7'r�Drl �: `Iiia d@ ENA ria E_ll��/)ccZ!"t.�r 7C�L7 <br />_7.HSCSection117908-Common <br />facility shall be registered with local enforcement <br />agency. <br />Procedures <br />li.. ) ' <br />be! A'yt- <br />-� r" !l �� ��� L <br />8.HSC Section 117935-SQG MWMP <br />_9.HSC Section 117943-SQG Shall keep <br />j ; y1 i� it �,l'_t� !+ Ir)s',- s P:� • �7 )cit-� <br />records for 3 years. <br />_10.HSC Section 117945-SQG not required to <br />register shall keep records for 2 years. <br />_11.HSC Section 117960-LQG shall file MWMP <br />"h enforcement agency. <br />,12.HSC Section 117975-LQG shall keep <br />records for 3 years. <br />Transportation <br />_13. NSC 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 />_16.HSC Section 118765 -All treatment records <br />shall be kept for 3 years. <br />_16.HSC Section 11 8215 -All medical waste'�ti, <br />shall be treated pursuant to this section. <br />_17.HSC Section 118220 -Recognizable human <br />anatomical pads shall be disposed of by interment <br />unless otherwise hazardous. <br />_18.1-ISC Section 118225 -Treated sharps shall <br />r'� r'�t� .'i t e: g t11 .y b`7-/ rrl, <br />z I <br />r-) ?1'r .� fa l . �� °, t' I!5CLDO <br />�n� <br />4%�1 blA 7 A,V Z�l 'J `� r .1e'.6.� );Y' _ _ N'.,7�C �' . ())�lirst.+(aGu.'t?tii <br />° i •�, , J ') <br />r ° 7 c -CvJi E,rtG,-zej-y x �. J i�z��,� l <br />S�!✓t1.('�1 �t;�t r 'f11r7 e%iY' r ���)eJ)ifp.r �F.r'P'_� e� <br />$e destroyed or somehow prevent public access. <br />%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 />Z23.HSC Section 118307 -Interim storage labeled <br />_24.HSC Section 118310 -Enclosure labeled. <br />t <br />' <br />ofd <br />_25.HSC Section 118305 -Cannot reuse drums <br />_ 26.HSC Section 117630 -Approved biohazard <br />bag used.% <br />_27.HSC Section 118275(8)-Pharm iabel/store <br />—28.HSC Section 118222 -Incineration Required <br />R�yed By -- Date f <br />0-406itor Signature eC <br />29 Other -Describe in narrative. <br />