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�QPqufy �Q SAN JOAQUIN COUNTY Date Z <br /> i E IRONMENTAL HEALTH DEPARTMEP PR IS_3 <br /> { 600 East Main Street, Stockton, CA 95202 <br /> ® (209)468-3420 <br /> P MEDICAL WASTE INSPECTION FORM <br /> FacilityName 6y. yop,j LC t4z FacilityAddress h'j® � <br /> FacilityContact ktDow PA-v,,ye, Title Phone# LS.3"t -76 <br /> INSPECTION TYPE: p9outine []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 r <br /> agency prior to commencement of the generation of G J= hf Q La�L dare - <br /> medical waste. <br /> _2.HSC Section 117903-Permit from the <br /> enforcement agency required to treat medical <br /> waste. I `` <br /> _3.HSC Section 117890-No large LQG shall Q r ® )Z <br /> generate medical waste unless registered with the <br /> enforcement agency. \dam fit' `��c--� � "✓��� cel. f <br /> _4.HSC Section 117895-SQG that treats med s ✓�U�� ��� S <br /> waste shall register with enforcement agency. <br /> _5.HSC Section 117900-Shall not haul med <br /> waste unless registered or obtained LQHE. q <br /> _6.HSC Section 117903-Shall not treat med CSYt ti 6'� 1 �r_ -� im M"-e— K <br /> waste without permit from enforcement agency. <br /> _7.HSC Section 117908-Common Storage <br /> facility shall be registered with local enforcement <br /> agency. ry <br /> Procedures <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 /> re aster shall keep records for 2 years. t l ✓ 6 3 L.mr 12� <br /> 1.HSC Section 117960-LQG shall file MWMP `® <br /> with enforcement agency. V amt 1:�L1ly, ZI2.rT)ez,::1yALS hT <br /> _12.HSC Section 117975-LQG shall keep / __\\ <br /> records for 3years. `� Yyl L CIt ,IYt `V <br /> Transportation Q QiQ.v. 5��Lel®� M4 L"<:�C <br /> _13.HSC Section 118030-LQHE application. <br /> Treatment/Storage J u '' Z <br /> _14.HSC Section 118135-Shall obtain a permit C <br /> from the enforcement agency to treat medical <br /> waste prior to treating the waste. U #la-r,1/1/e zed LP�L-as 2 Z 41®,.\ <br /> _15.HSC Section 118765-All treatment records <br /> shall be kept for 3 years. OA <br /> _16.HSC Section 11821 5-All medical waste <br /> shall be treated pursuant to this section. <br /> _17.HSC Section 118220-Recognizable human -� 0C:C VY" <br /> anatomical parts shall be disposed of by interment <br /> unless otherwise hazardous. L- L <br /> _18.HSC Section 118225-Treated sharps shall �` <br /> be destroyed or somehow prevent public access. A -, ' <br /> _19.HSC Section 118275-MW red bags,path, <br /> chemo shall be labeled properly. <br /> V-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. �� is <br /> J <br /> 27.HSC Section 118275(g)-Pharm label/store <br /> _28.HSC Section 118222-Incineration Required I C ignature R ei ed By Date <br /> 29 Other-Describe in narrative. <br /> P - <br />