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4L <br /> SAN JOAQUIN COUNTY Date <br /> ENVIRONMENTAL HEALTH DEPARTMENT PR OG' I OL 0,0 <br /> 1868 East Hazelton Ave., Stockton, CA 95205 <br /> (209)468-3420 <br /> MEDICAL WASTE INSPECTION FORM <br /> Faci1ityName.. .-Njkp% 5,e-i r cx N:alik-5i s —FacilityAddress ss:5 w. <br /> FacilityContact kAqr' 9-e1 Title Phone# <br /> INSPECTION TYPE: ARoutine []Complaint olte-inspection <br /> VIOLATION(S) <br /> Registration THE ITEMS BELOW REPRESENT VIOLATIONS OF THE CALIFORNIA <br /> 1.NSC 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 /> ck;�'Dj)'N <br /> 2.HSC Section 117903-Permit from the <br /> -e-n—forcement agency required to treat medical <br /> waste. <br /> —3.HSC Section 117890-No large LQG shall <br /> generate medical waste unless registered with the r 11 <br /> enforcement agency. fvinl <br /> —4.HSC Section 11 7895-SQG that treats medLock eolst ar) 5 T <br /> It U41c\to('An Tcklt <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 Tho M#A%'wak Mun-,:liuWA 916%4-N W104 <br /> waste without permit from enforcement agency. <br /> THSC Section 117908-Common Storage <br /> Taicility shall be registered with local enforcement <br /> agency. -A <br /> Procedures IjT4 fnl, KVI�JgAj WUSIt, <br /> 8.HSC Section 117935-SQG MWMP <br /> —9.HSC Section 117943-SQG Shall keep <br /> records for 3 years. tINAP A-tv'UWA-1 (CLOrAs �nAl <br /> —10.HSC Section 117945-SQG not required to <br /> register shall keep records for 2 years. 033(t/'enn(A?'1.) As,, fe'(ZjjC'- <br /> 1 1.HSC Section 117960-LQG shall file MWMP 1 <br /> with enforcement agency. <br /> E!5 rAA' i A VC%51 1 JlNiLn�pl' <br /> 12.HSC Section 117975-LQG shall keep WN( I )LIa� 0\)TIA )CA 5= <br /> records for 3 years. <br /> Transportation <br /> 13.HSC Section 11 8030-LQHE application. <br /> fr-eatment/Sto rage <br /> 14.HSC Section 118135-Shall obtain a permit <br /> Fro-m the enforcement agency to treat medical <br /> waste prior to treating the waste. <br /> 15.HSC Section 118765-All treatment records <br /> s-h-all be kept for 3 years. <br /> 16.HSC Section 118215-All medical waste <br /> shall be treated pursuant to this section. <br /> ITHSC Section 118220-Recognizable human <br /> anatomical parts shall be disposed of by interment <br /> unless otherwise hazardous. <br /> 18.1-11SC Section 118225-Treated sharps shall <br /> bedestroyedor somehow prevent public access. <br /> 19.1-11SC 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 label1contain <br /> —22.HSC Section 118295-Proper decon used. <br /> —23.HSC Section 1118307-Interim storage labeled <br /> 24.HSC Section 118310-Enclosure labeled. <br /> —26.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 inspet"711or Signature RAceived y at <br /> 29 Other-Describe in narrative. <br />