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°UI" MEDICAL WASTLOSPECTION REPORT Date: all I�[7 :....�o y San Joaquin County Environmental Health Department Pro gram 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: TARO S 2 G (209)468-3420 Program c4<:1caa`'�P www.sjogv.org/ehd Element: 44650 Facility Name Address City Zip Code DaVita Lodi Dialysis Center 1610 w kettleman lane Lodi 95240 Facility Contact Title Phone Number Email Inspection Type Stormee King Facility Administrator 209-334-9888 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 LQG shall generate medical waste unless HSC 118130-All onsite medical waste treatment facilities shall El 1 registered with the EA. El 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 19 HSC 118215-All medical waste shall be treated pursuant to El 3. medical waste. ❑ 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 22. HSC 118225-Sharps waste shall be treated pursuant to this ❑ 6' fissured by the EA. ❑ section. ❑ 7 HSC 117890-LQG shall notify EA 72 hours prior to Containment/Storage participating in temporary event. HSC 117895-SQG shall notify EA 72 hours prior to ® 23 HSC 117630-Biohazard bag shall meet the standards set forth ❑ 8. 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. HSC 117943-SQG required to register shall maintain HSC 118285-Sharps waste shall be containerized and stored ❑ 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 27 HSC 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. El 28. waste shall not be used for other storage. HSC 117975-LQG shall maintain treatment and shipping and 29HSC 118307- Intermediate storage area shall be secured and ❑ 13. tracking documents for 2 years. ❑ . marked with proper signage. Transportation ❑ 30. HSC 118310-Designated accumulation area shall be secured pp and marked with proper signage. ❑ 14. HSC 117946-MOT exemption requirements for SQG. Other ❑ 15. HSC 117976-MOT exemption requirements for LQG. ® 31. HSC 117630-Container is not lined. ❑ 16. HSC 118032-Pharmaceutical waste hauling exemption. ❑ 32. Received by: Print: Stormee King Signature: , Phone:209-334-9888 Specialist: Print: Sandip Singh Sign t re:::: Phone: 209-468-3526 Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Page 1 of 2 EH-11/17 N6