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MEDICAL WASTWISPECTION REPORT • Date: 8L �tS �'1a San Joaquin County Environmental Health Department Program rte, 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: i02 (209)468-3420 Program cqc F'oaa p www.siogv_org/ehd Element: q 53 o Facility Name Address City Zip Code American Medical Response 400 s.fresno st. Stockton 95203 Facility Contact Title Phone Number Email Inspection Type Shawn Gossen Deployment Coordinator (209)405-0622 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 El HSC 118130-All onsite medical waste treatment facilities shall 1' registered with the EA. 17 be permitted by the EA. ❑ HSC 117950-LQG shall register with the EA prior to 2. generating medical waste. F118. HSC 118165-All treatment records shall be kept for 3 years. ❑ HSC 117903-Permit from the EA is required prior to treating HSC 118215-All medical waste shall be treated pursuant to 3' medical waste. ❑ 19' this section. HSC 117925-SQG that treats medical waste onsite shall HSC 118220-Pathology waste of a human nature shall be E] 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 HSC 118225-Sharps waste shall be treated pursuant to this 6' issured by the EA. ❑ 22' 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 HSC 117630-Biohazard bag shall meet the standards set forth 8' participating in temporary event. El 23' 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. El 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 El 10. treatment and shipping and tracking records for 3 years. E] 26' pursuant to this section. HSC 117945-SQG not required to register shall maintain HSC 118295-Containers shall be washed and decontaminated El 11. information document and transportation records for 3 years. El 27' pursuant to this section. HSC 118305- Reuseable drums or conainters used for medical ® 12. HSC 117960-LQG shall file MWMP with the EA. ❑ 28. waste shall not be used for other storage. ® HSC 117975-LQG shall maintain treatment and shipping and HSC 118307- Intermediate storage area shall be secured and 13. tracking documents for 2 years. El 29' marked with proper signage. Transportation ❑ 30. HSC 118310-Designated accumulation area shall be secured and marked with proper signage. ❑ 14. HSC 117946-MOT exemption requirements for SQG. Other ❑ 15. HSC 117976-MOT exemption requirements for LQG. ❑ 3 El 16. HSC 118032-Pharmaceutical waste hauling exemption. ❑ :32j_ Received b : Print: Shawn Gossen Signature: Phone:(209)405-0622 Specialist: Print: Benjamin Escotto,Sr REHS Signature: �l.rYwv�, Phone:(209)468-3178 d Reinspecion on/about: A reinspection fee of$130 per hour may be charged. Page 1 of 2 EH-08/2015