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SAN JOAQUIN COUNTY Date <br /> ENVIRONMENTAL HEALTH DEPARTMENT FIR Os- ,VAD <br /> 1868 East Hazelton Ave., Stockton, CA 95205 <br /> (209)468-3420 <br /> MEDICAL WASTE INSPECTION FORM <br /> FacilityName f) tkq*, - Tfff 1AA D11 J%j S —FacilityAddress L12S Lm- &,ygA, (lobi-` tA <br /> 'i NJ <br /> FacilityContact--1 &XAIC^ Title j-'f- rq'ilk34A4,rN,,, Phone#J�04)w-o 31g <br /> INSPECTION TYPE: Moutine oComplaint olte-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 NQ 2,921 IIII&NS 091 <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 ther LiA <br /> enforcement agency. eAIA <br /> 4 0411�NL�tv. MIA, <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 bT ltv�.?-�✓AL L- IS-I:VV L 16 1 L42i- 1139A�C 1, 1&9 <'+C- <br /> waste without permit from enforcement agency. <br /> 7.HSG Section 117908-Common Storage <br /> facility shall be registered with local enforcement <br /> agency. <br /> Procedures 619 fy <br /> 8.HSC Section 117935-SQG MVVMP <br /> —9.HSC Section 117943-SQG Shall keep <br /> records for 3 years. i3c4A�,Y*4 q4 1A um&ke- i W e-)0t <br /> —10.1-11SC Section 117945-SQG not required to <br /> register shall keep records for 2 years. (kWilhIlga f0it,JA�l WMk 'iJ)'4jtk(4&1 <br /> 11.HSC Section 117960-LQG shall file MWMP L11ir <br /> with enforcement agency. <br /> —12.HSC Section 117975-LQG shall keep <br /> records for 3 years. <br /> Transportation 0.:�(All ulaju))1R (Vjk (0A-A,(, )'()"J)'o J) <br /> 13.HSC Section 118030-LQHE application. <br /> Treatment/Storage14.HSC Section 118135-Shall obtain a permit LLAILnt ac�zcoll 4r)5!16)\ <br /> Fron the enforcement agency to treat medical \j <br /> waste prior to treating the waste. <br /> 15.HSC Section 11 8765-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 /> 1 8.HSC Section 118225-Treated sharps shall <br /> be_destroyed 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. <br /> —27.1-11SC Section 11 8275(g)-Pharm label/store <br /> —28.HSC Section 118222-Incineration Required Inspdktor Signature Received By Date' <br /> 29 Other-Describe in narrative. <br />