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,op4"'" eoG MEDICAL WASTASPECTION REPORT Date: 2. _Z %hi k San Joaquin County Environmental Health Department Program 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: PR 0C3:L,y6 (209)468-3420 Program c4��'coRr'\P www.sElement: iogv.orq/ehd L4 S3 6 Facility Name Address City Zip Code Davita Tracy Dialysis 425 w.beverly plaza#a Tracy 95376 Facility Contact Title Phone Number Email Inspection Type Laura Ramirez Facility Administrator (209)839-0398 Routine The above facility is inspected for compliance with Division 104,Part 14 of California Health and Safety Code(HSC). Registration Treatment ❑ HSC 117890-No LOG shall generate medical waste unless HSC 118130-All onsite medical waste treatment facilities shall 1' registered with the EA. ❑ 17 be permitted by the E4. ❑ HSC 117950-LOG shall register with the EA prior to 2. generating medical waste. ❑ 18. HSC 118165-All treatment records shall be kept for 3 years. ❑ HSC 117903-Permit from the EA is required prior to treating HSC 118215-All medical waste shall be treated pursuant to 3' medical waste. El 19' this section. HSC 117925-SQG that treats medical waste onsite shall HSC 118220-Pathology waste of a human nature shall be ❑ 4. register with the EA. ❑ 20. disposed of by interment,incineration,or an approved alternative. HSC 117900-Shall not haul medical waste unless registered, HSC 118222-Contaminated pathology waste,trace chemo ❑ 5. common carrier,trauma scene practitioner,or exempted ❑ 21. waste,or pharm waste from health care settings shall be treated under the MOT exemption. by incineration or an approved alternative. HSC 117928-Common Storage Facility shall have permit HSC 118225-Sharps waste shall be treated pursuant to this El 6' issured by the EA. ❑ 22' section. ❑ 7 HSC 117890-LOG shall notify EA 72 hours prior to Containment/Storage participating in temporary event. HSC 117895-SQG shall notify EA 72 hours prior to HSC 117630-Biohazard bag shall meet the standards set forth ❑ 8' artici atin in temporary event. ❑ 23' in this section. HSC 118275-Medical,biohazardous,sharps,trace chemo, Records/Documentation ❑ 24 pathology,or pharmaceutical waste shall be segregated and contained pursuant to this section. The container shall be properly labeled. ❑ 9. HSC 117935-Registered SQG shall file MWMP with the EA. ❑ 25 HSC 118280- Biohazard bags shall be containerized and stored pursuant to this section. HSC 117943-SQG required to register shall maintain HSC 118285-Sharps waste shall be containerized and stored F1 10. 26 treatment and shipping and tracking records for 3 years. ❑ ' pursuant to this section. HSC 117945-SQG not required to register shall maintain HSC 118295-Containers shall be washed and decontaminated El 11. 27 information document and transportation records for 3 years. ❑ ' pursuant to this section. ® 12. HSC 117960-LOG shall file MWMP with the EA. ❑ 28 HSC 118305- Reuseable drums or conainters used for medical waste shall not be used for other storage. HSC 117975-LOG shall maintain treatment and shipping and HSC 118307- Intermediate storage area shall be secured and El 13. 29 tracking documents for 2 years. ❑ . marked with proper signage. Transportation ❑ 30. HSC 118310-Designated accumulation area shall be secured and marked with proper signage. ❑ 14. HSC 117946-MOT exemption requirements for SQG. Other ❑ 15. HSC 117976-MOT exemption requirements for LOG. ❑ 31. ❑ 16. HSC 118032-Pharmaceutical waste hauling exemption. ❑ 32. Received by: Print: Laura Ramirez Signature: ( /y Phone: 209 839-0398 Specialist: Print: Benjamin Escotto,Sr REHS Signature: Phone: 209 468-3178 Reinspecion oniabout: A reinspection fee of$130 per hour may be charged. Page 1 of 2 EH-0812015