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SAN JOAQUIN COUNTY Date -/-A ,-1 I <br /> EIRONMENTAL HEALTH DEPARTMEPI PR <br /> 600 East Main Street, Stockton, CA 95202 <br /> (209)468-3420 <br /> MEDICAL WASTE INSPECTION FORM <br /> Facility Namefaie,sk A FaciliAddress._-.o-Vcl I _,CA) d (1cA.,,cL\ L-6 a 141 <br /> FacilityContact Title f1iAyicAQe b,- Phone# q t6-C11!3-Ll 44-70 <br /> U <br /> INSPECTION TYPE: Moutine EICOMIilaint De-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 /> '6e-nerator 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 V�10 I AiNA e_ 1M t) zpk�A e,Avic)r <br /> -IA4C r <br /> enforcement agency required to treat medical 117 C <br /> waste. <br /> —3.HSC Section 117890-No large LQG shall <br /> generate medical waste unless registered with the <br /> enforcement agency. f2 1h C4. in L <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 /> THSC Section 117908-Common Storage <br /> facility shall be registered with local enforcement <br /> agency. <br /> Procedures <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 <br /> register shall keep records for 2 years. <br /> 1 I.HSC Section 11 7960-LQG shall file MWMP <br /> ;With enforcement agency. <br /> —12.HSC Section 117976-LQG shall keep <br /> records for 3 years. <br /> Transportation <br /> —13.HSC Section 11 8030-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 /> 15.HSC Section 118765-All treatment records <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 <br /> anatomical parts shall be disposed of by interment <br /> unless otherwise hazardous. <br /> 18.HSC Section 118225-Treated sharps shall <br /> b_e­destroyed 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 <br /> bag used. -4.// <br /> 27.HSC Section 118275(g)-Pharm label/store J4:"L. R_&Z? lAlk_Lk ' <br /> 2 29 Other-Describe in narrative. I414 <br /> 8.HSC Section 118222-Incineration Required _11�ct7o Received By Date <br /> -7 gnature <br />