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SAN JOAQUIN COUNTY Date 23-2Q-t Z <br /> a °Z E IRONMENTAL HEALTH DEPARTME PR 5-36i57-3 <br /> 600 East Main Street, Stockton, CA 95202 <br /> (209)468-3420 <br /> P MEDICAL WASTE INSPECTION FORM <br /> FacilityNameEIN, w�,e.rp 1 4 " A A FacilityAddress <Np 1r-m � _ <br /> FacilityContactTitle Phone# 3EQ -7&9 <br /> t VI <br /> INSPECTION TYPE: Moutine []Complaint []Re-inspection <br /> VIOLATION(S) <br /> Registration THE ITEMS BELOW REPRESENT VIOLATIONS OF THE CALIFORNIA <br /> _1.HSC Section 117955-Large Quantity HEALTH & SAFETY CODE (HSC): <br /> Generator shall register with the enforcement <br /> agency prior to commencement of the generation of <br /> medical waste. S <br /> _2.HSC Section 117903-Permit from the <br /> enforcement agency required to treat medical <br /> waste. <br /> _3.HSC Section 117890-No large LQG shall 4) < eD rb1 i Ga 712 Cc:�Q L) L r �L rL QV <br /> generate medical waste unless registered with the <br /> enforcement agency. <br /> _4.HSC Section 117895-SQG that treats med sc z l <br /> waste shall register with enforcement agency. <br /> _5.HSC Section 117900-Shall not haul med �• :ib® , r'l Q n fJV1e `� S <br /> waste unless registered or obtained LQHE. t <br /> _6.HSC Section 117903-Shall not treat med Q ��_ 1/13 lb l <br /> waste without permit from enforcement agency. / <br /> _7.HSC Section 117908-Common Storage <br /> facility shall be registered with local enforcement <br /> agency. <br /> Procedures <br /> _8.HSC Section 117935-SQG MWMP <br /> _9.HSC Section 117943-SQG Shall keep <br /> records for 3 years. 04ecYj <br /> _10.HSC Section 117945-SQG not required to <br /> T <br /> shall keep records for 2 years. y 1 <br /> 11.HSC Section 117960-LQG shall file MWMP <br /> with enforcement agency. <br /> _12.HSC Section 117975-LQG shall keep <br /> records for 3 years. <br /> Transportation / r <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 118765-All treatment records <br /> shall be kept for 3 years.'- I t�� Y?Jt�► t7L� (J <br /> _16.HSC Section 118215-All medical waste Y1 Q.1 -121,1_ -h:;) n®t ® a C7l 2, L G- <br /> shall be treated pursuant to this section. _ <br /> _17.HSC Section 118220-Recognizable human //? f <br /> anatomical parts shall be disposed of by interment �.�/ -gig <br /> unless otherwise hazardous. � I LCAl, d- _ _;Oz e a VLA LCeJ 1`— i�G® k'a <br /> _18.HSC Section 118225-Treated sharps shall <br /> be destroyed or somehow prevent public access. j za, c 11�1 <br /> _19.HSC Section 118275-MW red bags, path, cq--� C21 2-. cc.I& h a aY► cc mr_ <br /> chemo shall be labeled properly. <br /> X20.HSC Section 118280-MW label&contain �la.o.�r etc L r`�rv► �. L�JG✓� r>ttr� G✓aor7 <br /> _21.HSC Section 118285-Sharps label/contain <br /> 22.HSC Section 118295-Proper decon used. iti pk) §finys �VlQ_ ��� l,Jc, V►rac t )r- <br /> _23.HSC Section 118307-Interim storage labeled <br /> 24.HSC Section 118310-Enclosure labeled. �ti'�"r �' ✓�/� <br /> 25.HSC Section 118305-Cannot reuse drums <br /> _26.HSC Section 117630-Approved biohazard <br /> bag used. CIL <br /> _27.HSC Section 118275(g)-Pharm label/store <br /> _28.HSC Section 118222-Incineration Required r Signature Re IV By Date <br /> 29 Other-Describe in narrative. <br />