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12/14/2015 17:41 FAX 209 472 3300 [x]0003/0031 <br /> °. <br /> MEDICAL WAS INSPECTION REPORT <br /> . Date: <br /> S 11/� <br /> 2 Z an Joaquin County Environmental Health Department 2f Zd1S <br /> A <br /> p <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 ' Program ` � ® ��/ <br /> (209)468-3420 Record: ` 6, <br /> www.siogv,org/ehd Program <br /> Element: <br /> Facility Name Address <br /> City Zip Code <br /> Davila Stockton Kidney Center 1523 e.march in#200 Stockton 95210 <br /> Facility Contact Title Phone Number Email Inspection Type <br /> Isabel Armstrong Administrative Assistant (209)472-3300 <br /> Routine <br /> The above facility is inspected for compliance with Division 104,Part 14 of California Health and Safety Code(HSC). <br /> Reglatrlttbn Tceatinent <br /> ❑ 1 HSC 117890-No LQG shall generate medical waste unless ]:;HSC 118130-All onsite medical waste treatment facilities shall <br /> registered with the EA. ❑ 17• be <br /> HSC 11795Q-LQG shall register with the EA prior to permitted by the EA. <br /> ® 2' generating medical waste. ❑ 18. HSC 118165-All treatment records shall be kept for 3 years. <br /> ❑ <br /> 3. HSC 117903-Permit from the EA is required prior to treating HSC 118215-All medical waste shall be treated pursuant to <br /> medical waste. ❑ 19• <br /> this section. <br /> ❑ <br /> 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 <br /> alternative. <br /> HSC 117900-Shall not haul medical waste uniess registered, HSC 118222-Contaminated pathology waste,trace chemo <br /> ❑ 5. common carrier,trauma scene practitioner,or exempted ❑ 21. waste,or pharm waste from health care settings shall be treated <br /> under the MOT exemption. by incineration or an approved alternative. <br /> ❑ 6 HSC 117928.-Common Storage Facility shall have permit ❑ 22 HSC 118225-Sharps waste shatl be treated pursuant to this <br /> fissured by the EA. section. <br /> ❑ 7 HSC 117890-LQG shall notify EA 72 hours prior to <br /> participating in temporary event. Cbntatnrite�t/St0>tag@ <br /> 8 HSC 117895-SQG shall notify EA 72 hours prior to HSG 117630-Biohazard bag shalt meet the standards set forth <br /> participating in tem ora event. ❑ 23' in this section. <br /> HSC 118275-Medical,biohazardous,sharps,trace chemo, <br /> 91 <br /> 0t:ord$/lloCumentation: ❑ 24. pathology,or pharmaceutical waste shall be segregated and <br /> contained pursuant to this section. The container shall be <br /> _Rroperly labeled. <br /> ❑ 9. HSC 117935'-Registered SQG shall file MWMP with the EA. ® 25 HSC 118280- Biohazard bags shall be containerized and <br /> stored pursuant to this section. <br /> ❑ 10. HSC 117943-SQG required to register shall maintainHSC 118285-Sharps waste shall be containerized and stored <br /> treatment and shipping and tracking records for 3 years. ® 26" pursuant to this section. <br /> ❑ 11. HSC 117945-SQG not required to register shall maintain HSC 118295-Containers shall be washed and decontaminated <br /> information document and transportation records for 3 years. ❑ 27. pursuant to this section. <br /> ® 12. HSC 117960-LQG shall file MWMP with the EA. ❑ 28 HSC 118305- Reuseable drums or conainters used for medical <br /> waste shall not be used for other storage. <br /> ® 13 HSC 117975-LQG shall maintain treatment and shipping and HSC 118307- Intermediate storage area shall be secured and <br /> tracking documents for 2 years. ❑ 29. marked withi9 g <br /> proper signage. <br /> e. <br /> �Cs1113j3OTtalln; ® 30. HSC 118310-Designated accumulation area shall be secured <br /> and marked with proper signage. <br /> ❑ 14. HSC 117946-MOT exemption requirements for SQG. Other <br /> ❑ 15. HSC 117976-MOT exemption requirements for LQG. ❑ 31. <br /> ❑ 16. HSC 118032-Pharmaceutical waste hauling exemption. [] 32. <br /> Received by: Print: Isabel Armstrong Si nature: Phone: 209 472-3300 <br /> _ clalist: Print: Harprit Mattu Sr RENS Signature: GSI e® Phone (209)468-3284 <br /> Reinspecion onlabout: A reinspection fee of$130 per hour may be charged. <br /> EH-08/2015 Page 1 of 2 <br /> Received Tlme Dec, 14, 2015 5:49PM No. 1442 <br />