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uso, <br /> p.4u!NSAN JOAQUIN COUNTY Date9 -7ENVIRONMENTAL HEALTH DEPARTME �" PR O53(n20'7 <br /> 1868 East Hazelton Ave., Stockton, CA 95205 <br /> (209)468-3420 <br /> MEDICAL WASTE INSPECTION FORM <br /> FacilityName tAoApry NIgn aiv�o� bmlo! iFacilityAddress QW6. 0• (AIAPPA,'ti 1� SV;�e <br /> �J <br /> FacilityContact 14 S u S c, Title 041'a-- ti Phone# oA) <br /> INSPECTION TYPE: routine ❑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. C <br /> _2.HSC Section 117903-Permit from the <br /> enforcement agency required to treat medical mA S l G tk <br /> waste. j q <br /> _3.HSC Section 117890-No large LQG shall /� Pl , GI )'1' <br /> generate medical waste unless registered with the <br /> enforcement agency. 1 <br /> _4.HSC Section 117895-SQG that treats med a 0 3 rs j 4'A i Ct JC c& AAA <br /> waste shall register with enforcement agency. <br /> _5.HSC Section 117900-Shall not haul med . 10,.r5 ' y-, 6-U , <br /> S U <br /> waste unless registered or obtained LQHE. <br /> _6.HSC Section 117903-Shall not treat med k n w O- A A <br /> waste without permit from enforcement agency. <br /> _7.HSC Section 117908-Common Storage J W deacLSS11ryry 1. <br /> facility shall be registered with local enforcement GJ 1 66i1 14f1 "I �� �7 <br /> agency. <br /> Procedures <br /> _8.HSC Section 117935-SQG MWMP l}i (S k S <br /> _9.HSC Section 117943-SQG Shall keep <br /> records for 3 years. SC I (,t N) <br /> _10.HSC Section 117945-SQG not required to <br /> re ester shall keep records for 2 years. J�uJ C h I S, til Y� rh Gl 5 m 2� <br /> ter <br /> Section 117960-LQG shall file MWMP yL� r I 11 t <br /> with enforcement agency. t <br /> �7,02.HSC Section 117975-LQG shall keep S 6 rn44A �n V �- <br /> records for 3 years. <br /> Transportation G Irl'rIPJ !s <br /> _13.HSC Section 118030-LQHE application. ( Sl ll <br /> Treatment/Storage <br /> _14.HSC Section 118135-Shall obtain a permit j S � <br /> from the enforcement agency to treat medicalt <br /> waste prior to treating the waste. 1 6 A S Q.1 t <br /> _15.HSC Section 118765-All treatment records C� <br /> shall be kept for 3 years. <br /> _16.HSC Section 118215-All medical waste <br /> shall betreated pursuant to this section. <br /> _17.HSC Section 118220-Recognizable human <br /> anatomical parts shall be disposed of by interment , t <br /> unless otherwise hazardous. Wei,, �(,' �� � L�fl <br /> _18.HSC Section 118225-Treated sharps shallU CT UT Glrlt S 1 S <br /> be destroyed or somehow prevent public access. <br /> _19.HSC Section 118275-MW red bags, path, <br /> chemo shall be labeled properly. 'I <br /> _20.HSC Section 118280-MW label&contain C v '[ � j-C-tvl (1 14"m S <br /> _21.HSC Section 118285-Sharps label/contain <br /> _22.HSC Section 118295-Proper decon used. <br /> _23.HSC Section 118307-Interim storage labeled 1_ ��1� �5 J na� (amu nt���S <br /> U�4.HSC Section 118310-Enclosure labeled. Yl 1 1 <br /> _25.HSC Section 118305-Cannot reuse drums <br /> _26.HSC Section 117630-Approved biohazard _ ry <br /> bpq used. \� ' �v <br /> THSC Section 118275(g)-Pharm label/store '�'& <br /> _ 8.HSC Section 118222-Incineration Required Ins ctor Signature Received By Date <br /> 29 Other-Describe in narrative. <br />