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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Ave., Stockton, CA 95205 <br />(209) 468-3420 <br />MEDICAL WASTE INSPECTION FORM <br />Date .3 f aS 1H <br />PR 0 5a671% <br />FacilityName bwAip L®A; ®ialwsi. FacilityAddress 1610 w_ kthmte_A L.,_ p <br />FacilityContact ln�,, dnuci e, tA)VOOL <br />VIOLATION(S) <br />Registration <br />THE ITEMS BELOW REPRESENT VIOLATIONS OF THE CALIFORNIA <br />_ 1. NSC Section 117955 -Large Quantity <br />Generator shall register with the enforcement <br />HEALTH & SAFETY CODE (HSC): <br />agency prior to commencement of the generation of <br />medical waste. <br />_2. HSC Section 117903 -Permit from the <br />1 <br />--j' c d tt�tfl1i ntlT d A 4.�. <br />e.. 'ye- )W2 1i'1 e us �'1�h S ) �nS�GG Vivi, <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 the <br />enforcement agency. <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 />1 <br />may•_'- 1 U e u C5 'S ? ot ,r ' fA <br />' <br />Section 117903 -Shall not treat med <br />- 'AlM <br />- *Lt4� 1tnA" 1�n�� t P1wr was <br />_6.HSC <br />waste without permit from enforcement agency. <br />_THSC Section 117908 -Common Storage <br />facility shall be registered with local enforcement <br />At �►1 ul_1 •� j �v^I_ <br />agency. <br />, <br />Procedures <br />r <br />-� lr l <br />_8.HSC Section 117935-SQG MWMP <br />_9.HSC Section 117943-SQG Shall keep <br />records for 3 years. <br />_10.HSC Section 117945-SQG not required to <br />register shall keep records for 2 years. <br />�- r� ,, �/ nn �, c r�•T�n`' 1 lc nJ� S <br />1 M1A1t r <br />CM 1A1 <br />11.HSC Section 117960-LQG shall file MWMP <br />with enforcement agency. <br />t L t SvSO +n fA' 111 ICA to <br />_12.HSC Section 117975-LQG shall keep <br />records for 3 years. <br />Transportation <br />— 13. HSC Section 118030-LQHE application. <br />Treatment/Storage <br />_14.HSC Section 118135 -Shall obtain a permit <br />From the enforcement agency to treat medical <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 />_18.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.HSC Section 118275(8)-Pharm label/store <br />() + ,, I <br />,1� dig <br />28.HSC Section 118222 -Incineration Required <br />29 Other -Describe in narrative. <br />InsoUctor Signature edty Date <br />