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�oPq!!►!v. Co SAN JOAQUIN COUNTY Date <br /> 2: 2 ENVIRONMENTAL HEALTH DEPARTMENT PR _G'-KA, 13 <br /> Q. 600 East Main Street, Stockton, CA 95202 <br /> N' (209)468-3420 <br /> MEDICAL WASTE INSPECTION FORM <br /> ��►FORS <br /> FacilityName AI&D E qe_as n, FacilityAddress ,�r�� �ri�l►.mc� ?�/ _- <br /> FacilityContactA1 TitledTV-n_-� _Phone# R �-2,97_S <br /> INSPECTION TYPE: �Soutine []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. <br /> _2.HSC Section 117903-Permit from the J� 1 m ox_ -A✓rte_ 1 0-'4< <br /> enforcement agency required to treat medical gFrA.A �� elk n 14 4 ,.,� <br /> waste. 1— <br /> _3.HSC Section 117890-No large LQG shall ►'1 `5•Ale- 'fig_ jxd)!I '711D lM�r`�fa?.e.i 0-1':.�ir- <br /> generate medical waste unless registered with the \ <br /> enforcement agency. <br /> _4.HSC Section 117895-SQG that treats med ASL _ <br /> waste shall register with enforcement agency. <br /> _5.HSC Section 117900-Shall not haul med - <br /> r <br /> waste unless registered or obtained LQHE. . <br /> _6.HSC Section 117903-Shall not treat med (7" "1i MOV M tj <br /> waste without permit from enforcement agency. <br /> _7.HSC Section 117908-Common Storage " <br /> facility shall be registered with local enforcement <br /> agency. <br /> Procedures .;?_ 6,11 <br /> 8.HSC Section 117935-SQG MWMP ' <br /> _9.HSC Section 117943-SQG Shall keep <br /> records for 3 years. (> <br /> _10.HSC Section 117945-SQG not required to 106A ieA4 <br /> register shall keep records for 2 years. <br /> _Xj1.HSC Section 117960-LQG shall file MWMP <br /> with enforcement agency. �`alQo <br /> _12.HSC Section 117975-LQG shall keep " <br /> records for 3 years. <br /> Transportation <br /> _13.HSC Section 118030-LQHE application. <br /> Treatment/Storage <br /> _14.HSC Section 118135-Shall obtain a permit <br /> from the enforcement agency to treat medical n <br /> waste prior to treating the waste. <br /> _15.HSC Section 118765-All treatment records �_ r ` CNIN •���, I!1r .1l ��- <br /> shall be kept for 3 years. --Li..,-. <br /> _16.HSC Section 118215-All medical waste cC e� 4 <br /> shall be treated pursuant to this section. <br /> 1��nP�JW1c'. <br /> _17.HSC Section 118220-Recognizable human IA4 g- <br /> anatomical parts shall be disposed of by interment <br /> unless otherwise hazardous. r Al <br /> _18.HSC Section 118225-Treated sharps shall e <br /> be destroyed or somehow prevent public access. ` r <br /> yyy <br /> _19.HSC Section 118275-MW red bags,path, c'1 h. ._An lzle�. <br /> chemo shall be labeled properly. n <br /> �20.HSC Section 118280-MW label&contain .YY j1 Z c— L'f CT <br /> _21.HSC Section 118285-Sharps label/contain J � <br /> _22.HSC Section 118295-Proper decon used. 111r.��':) ew OL em- �✓V1C i/ G �lLr' Lf Y1G'✓G; IJYI <br /> _23.HSC Section 118307-Interim storage labeled .� M \ S <br /> X24.HSC Section 118310-Enclosure labeled. <br /> _25.HSC Section 118305-Cannot reuse drums <br /> _26.HSC Section 117630-Approved biohazard <br /> bag used. WD <br /> �7.HSC Section 118275(g)-Pharm label/store� 7_28.HSC Section 118222-Incineration Required I r Signature Receiveda <br /> YL29 Other-Describe in narrative. <br />