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MEDICAL WAS TSPECTION REPORT Date: l I its _ s San Joaquin County Environmental Health Department Program 1868 E. Hazelton Ave., Stockton, CA 95205 Record: (209) 468-3420 Program 4c%FOR`'�p www.sJogv.org/ehd Element: 4 53D Facility Name Address City Zip Code Davila Lodi Dialysis Center 1610 w. kettleman In. #d Lodi 95242 Facility Contact Title Phone Number Email Inspection Type Robbi Kuehne Administrator (209) 334-9888 Routine The above facility is inspected for compliance with Division 104, Part 14 of California Health and Safety Code (HSC). Received by: Print: Robbi Kuehne Si natu I Phone: 209 334-9888 /L - Specialist: Print: Benjamin Escotto, Sr REHS Signature: Phone: 209 468-3178 Reinspecion on/about: A reinspection fee of $130 per hour may be charged. Page 1 of 2 EH -08/2015 Registration Treatment ❑ 1 HSC 117890 - No LQG shall generate medical waste unless ❑ 17 HSC 118130 - All onsite medical waste treatment facilities shall registered with the EA. be permitted by the EA. ❑ 2 HSC 117950 - LQG shall register with the EA prior to ❑ 18. HSC 118165 -All treatment records shall be kept for 3 years. generating medical waste. ❑ 3 HSC 117903 - Permit from the EA is required prior to treating ❑ 19 HSC 118215 - All medical waste shall be treated pursuant to medical waste. this section. ❑ 4. HSC 117925 - SQG that treats medical waste onsite shall ❑ 20. HSC 118220 - Pathology waste of a human nature shall be register with the EA. 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. ❑ 6 HSC 117928 - Common Storage Facility shall have permit ❑ 22 HSC 118225 - Sharps waste shall be treated pursuant to this issured by the EA. section. ❑ 7' HSC 117890 - LQG shall notify EA 72 hours prior to Containment/Storage participating in temporary event. ❑ 8 HSC 117895 - SQG shall notify EA 72 hours prior to ❑ 23 HSC 117630 - Biohazard bag shall meet the standards set forth participating in temporary event. 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. ❑ 10. HSC 117943 - SQG required to register shall maintain ❑ 26 HSC 118285 - Sharps waste shall be containerized and stored treatment and shipping and tracking records for 3 years. pursuant to this section. ❑ 11 HSC 117945 - SQG not required to register shall maintain ❑ 27 HSC 118295 - Containers shall be washed and decontaminated information document and transportation records for 3 years. pursuant to this section. ® 12. HSC 117960 - LQG shall file MWMP with the EA. ❑ 28 HSC 118305 - Reuseable drums or conainters used for medical waste shall not be used for other storage. ® 13. HSC 117975 - LQG shall maintain treatment and shipping and ❑ 29 HSC 118307- Intermediate storage area shall be secured and 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 LQG. ❑ 31. ❑ 16. HSC 118032 - Pharmaceutical waste hauling exemption. 2. Received by: Print: Robbi Kuehne Si natu I Phone: 209 334-9888 /L - Specialist: Print: Benjamin Escotto, Sr REHS Signature: Phone: 209 468-3178 Reinspecion on/about: A reinspection fee of $130 per hour may be charged. Page 1 of 2 EH -08/2015