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("! ._ \i MEDICAL WASTEOSPECTION REPORT Date: San Joaquin County Environmental Health Department Program G 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: `� 2Z L I a (209)468-3420 Program 44%F&izvx www.siogv.org/ehd Element: 1536 Facility Name Address City Zip Code DaVita Tracy Dialysis 425 w.beverly place#a Tracy 95376 Facility Contact Title Phone Number Email Inspection Type Shauntelle O'Connell Facility Administrator 209-839-0398 S l n)pj( .('-Lorrq,1 routine (ICA Vo-fa, .Gerj The above facility is inspected for compliance with Division 104,Part 14 of California Health and Safety Code(HSC). Registration Treatment HSC 117890-No LQG shall generate medical waste unless HSC 118130-All onsite medical waste treatment facilities shall F1 1' registered with the EA. ❑ 17' be permitted by the EA. ❑ HSC 117950-LQG shall register with the EA prior to 2' ❑ 18. HSC 118165-All treatment records shall be kept for 3 years. generating medical waste. 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. El 22' section. HSC 117890-LQG shall notify EA 72 hours prior to ❑ 7' participating in temporary event. Containment/Storage HSC 117895-SQG shall notify EA 72 hours prior to HSC 117630-Biohazard bag shall meet the standards set forth El 8. participating in temporary event. El 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 El 10. treatment and shipping and tracking records for 3 years. El 26. pursuant to this section. HSC 117945-SQG not required to register shall maintain 27HSC 118295-Containers shall be washed and decontaminated ❑ 11. information document and transportation records for 3 years. . pursuant to this section. HSC 118305- Reuseable drums or conainters used for medical ❑ 12. HSC 117960-LQG shall file MWMP with the EA. ❑ 28. waste shall not be used for other storage. HSC 117975-LQG shall maintain treatment and shipping and HSC 118307- Intermediate storage area shall be secured and El 13. tracking documents for 2 years. El 29' marked with proper signage. Transportation El 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 LQG. ❑ 31. ❑ 16. HSC 118032-Pharmaceutical waste hauling exemption. ❑ 32. Received by: Print: Shauntelle O'Connell Signature: Phone:209-839-0398 Specialist: Print: J. Easter Signature: MAIO[ Phone: 209-953-7310 Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Page 1 of 2 EH-11/17