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MEDICAL WASTE&PECTION REPORT 0 <br /> .� Date: 1 �e2 c/ /.O <br /> San Joaquin County Environmental Health Department Program <br /> 1868 E. Hazelton Ave.,Stockton,CA 95205 Record: PSZ052aG 4 b <br /> (209)468-3420 Program <br /> c4 !Foa?' www.siogy.org/ehd Element: 4566 <br /> Facility Name Address City Zip Code <br /> DaVita Tracy Dialysis 425 beverly place#a Tracy 95376 <br /> Facility Contact Title Phone Number Email Inspection Type <br /> Courtney Vela Facility Administrator 209-839-0398 Routine <br /> The above facility is inspected for compliance with Division 104,Part 14 of California Health and Safety Code(HSC). <br /> Registration Treatment <br /> HSC 117890-No LQG shall generate medical waste unless HSC 118130-All onsite medical waste treatment facilities shall <br /> F1 1 registered with the EA. El 17' be permitted by the EA. <br /> ❑ <br /> HSC 117950-LQG shall register with the EA prior to 2 ❑ 18. HSC 118165-All treatment records shall be kept for 3 years. <br /> generating medical waste. <br /> HSC 117903-Permit from the EA is required prior to treating HSC 118215-All medical waste shall be treated pursuant to <br /> ❑ 3. medical waste. ❑ 19. this section. <br /> HSC 117925-SQG that treats medical waste onsite shall HSC 118220-Pathology waste of a human nature shall be <br /> ❑ 4. register with the EA. ❑ 20. disposed of by interment,incineration,or an approved <br /> alternative. <br /> HSC 117900-Shall not haul medical waste unless registered, HSC 118222-Contaminated pathology waste,trace chemo <br /> ❑ 5. common carrier,trauma scene practitioner,or exempted ❑ 21. waste,or pharm waste from health care settings shall be treated <br /> under the MOT exemption. by incineration or an approved alternative. <br /> HSC 117928-Common Storage Facility shall have permit HSC 118225-Sharps waste shall be treated pursuant to this <br /> ❑ 6' issured by the EA. El 22 section. <br /> ❑ 7 HSC 117890-LQG shall notify EA 72 hours prior to Containment/Storage <br /> participating in temporary event. <br /> HSC 117895-SQG shall notify EA 72 hours prior toHSC 117630-Biohazard bag shall meet the standards set forth <br /> El8. participating in temporary event. El23. in this section. <br /> HSC 118275-Medical,biohazardous,sharps,trace chemo, <br /> Records/Documentation ❑ 24 pathology,or pharmaceutical waste shall be segregated and <br /> contained pursuant to this section. The container shall be <br /> properly labeled. <br /> ❑ 9. HSC 117935-Registered SQG shall file MWMP with the EA. ❑ 25 HSC 118280- Biohazard bags shall be containerized and <br /> stored pursuant to this section. <br /> HSC 117943-SQG required to register shall maintain HSC 118285-Sharps waste shall be containerized and stored <br /> El 10. treatment and shipping and tracking records for 3 years. [j 26. pursuant to this section. <br /> HSC 117945-SQG not required to register shall maintain HSC 118295-Containers shall be washed and decontaminated <br /> ❑ 11. information document and transportation records for 3 years. F1 27' pursuant to this section. <br /> ❑ 12. HSC 117960-LQG shall file MWMP with the EA. ❑ 28 HSC 118305- Reuseable drums or conainters used for medical <br /> waste shall not be used for other storage. <br /> HSC 117975-LQG shall maintain treatment and shipping and HSC 118307- Intermediate storage area shall be secured and <br /> ❑ 13. tracking documents for 2 years. ❑ 29' marked with proper signage. <br /> Transportation n 30 HSC 118310-Designated accumulation area shall be secured <br /> and marked with proper signage. <br /> ❑ 14. HSC 117946-MOT exemption requirements for SQG. Other <br /> ❑ 15. HSC 117976-MOT exemption requirements for LQG. ❑ 31. <br /> ❑ 16. HSC 118032-Pharmaceutical waste hauling exemption. ❑ 32. <br /> Received by: Print: Courtney Vela Signature: C/,, Phone:209-839-0398 <br /> Specialist: Print Sandip Singh Signature: (�2� �� c/� , Inv Phone: 209-468-3526 <br /> Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Pa 1 of 2 <br /> EH-11/17 <br />