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SAN JOAQUIN COUNTY Date VLAIII <br /> ENVIRONMENTAL HEALTH DEPARTM ► T PR 0,<&O)21 <br /> 600 East Main Street, Stockton, CA 95202 <br /> (209)468-3420 <br /> Q<<P ORS <br /> MEDICAL WASTE INSPECTION FORM <br /> y <br /> Facili a eTfat,A �c11, cili ress SNS t�. �e�eer�l( \ , <br /> FacilityContact NNA41 1'151e, Title ASA nninis-�''at, ar Phone C�� ��35-�03y <br /> Q <br /> INSPECTION TYPE: A, outine ❑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. � j wuia.CU 1 O <br /> 2.HSG Section 117903-Permit from the <br /> enforcement agency required to treat medical <br /> waste. \_ <br /> _3.HSC Section 117890-No large LQG shall SUIL� Cn hers 1 <br /> generate medical waste unless registered with theN S ktp <br /> enforcement agency. U <br /> _4.HSC Section 117895-SQG that treats med �\Ke 1 d!1 Lf, 0�s Qb [�n isL.b� �� 11 <br /> waste shall register with enforcement agency. <br /> _5.HSC Section 117900-Shall not haul med WlI,5a&L <br /> waste unless registered or obtained LQHE. a3 I �` ` <br /> _6.HSC Section 117903-Shall not treat med <br /> waste without permit from enforcement agency. S tl� f <br /> _7.HSC Section 117908-Common Storage l- <br /> facility shall be registered with local enforcement ver b i7 r1 m rl U <br /> agency. <br /> Procedures site, s . u�Elig L cr5yn.T 2P,0 <br /> _8.HSC Section 117935-SQG MWMP 1 h <br /> _9.HSC Section 117943-SQG Shall keep l <br /> records for 3 years. �IAA <br /> VNANring_ <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 l Q <br /> With enforcement agency. � 1 0301 b ' ,,k l ' S 1 <br /> _12.HSC Section 117975-LQG shall keep o� t <br /> records for 3 years. Cl1C,c�S �t n �IUV �,,vr,__ _Q _l?(h�f__wctf )l_=�t <br /> Transportation 5i {1 : S s 1 r m n a Utb n <br /> _13.HSC Section 118030-LQHE application. ® j ' Swa- In <br /> Treatment/Storage 11- r <br /> _14.HSC Section 118135-Shall obtain a permit !�i J�c;Vo r W (�u f �( ' wtv C fl 1 C. <br /> From the enforcement agency to treat medical !! , !- , , <br /> waste prior to treating the waste. U`v CU 1'' S n 1� <br /> _15.HSC Section 118765-All treatment records <br /> shall be kept for 3 years. 1 <br /> _16.HSC Section 118215-All medical wasteill Vj y <br /> shall be treated pursuant to this section. '' 9 C� a101IS <br /> Ql <br /> _17.HSC Section 118220-Recognizable human fx\® � b{'n{ (9It, 1 t �'p1 ft. <br /> anatomical parts shall be disposed of by interment ���� MCAl m � A 4-r)unless otherwise hazardous. 11) <br /> _18.HSC Section 118225-Treated sharps shall 1" - <br /> be destroyed or somehow prevent public access. G.S�-Uv -k�nGL 1S 21 1�1 ' _t..)�'c'1 <br /> _19.HSC Section 118275-MW red bags,path, ®S1r L 1 0 f 'Suc ' JC,_t4t, <br /> chemo shall be labeled properly. e 1 <br /> X 20.HSC Section 118280-MW label&contain nc\ U i SCS 4 4-110C®12 MJ 1 <br /> _21.HSC Section 118285-Sharps label/contain , <br /> _22.HSC Section 118295-Proper decon used. 1 3 <br /> x23.HSC Section 118307-Interim storage labeled <br /> ,g_24.HSC Section 118310-Enclosure labeled. <br /> _25.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 Insp or Signature Received By Date <br /> 29 Other-Describe in narrative. <br /> PAS E 1 <br />