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Ao MEDICAL WASTIIISPECTION REPORT Date: N San Joaquin County Environmental Health Department Program F7 p 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: (209)468-3420 Program www.siogv.org/ehd Element: Facility Name Address City Zip Code Innovation Dental 702 porter ave f Stockton 95207 Facility Contact Title Phone Number Email Inspection Type Quan Nguyen Owner (209)478-9648 innovationdental Routine @sbeglobal.net 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 HSC 118130-All onsite medical waste treatment facilities shall F1 1 registered with the EA. El 17. be permitted by the EA. ❑ 2 HSC 117950-LQG shall register with the EA prior to generating medical waste. El18. HSC 118165-All treatment records shall be kept for 3 years. ❑ 3 HSC 117903-Permit from the EA is required prior to treating ❑ 19 HSC 118215-All medical waste shall be treated pursuant to medical waste. this section. 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 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. ❑ 6 HSC 117928-Common Storage Facility shall have permit ❑ 22 HSC 118225-Sharps waste shall be treated pursuant to this issured by the EA. section. HSC 117890-LQG shall notify EA 72 hours prior to F] 7. 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 El 8. participating in temporary event. ❑ 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. ® 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. ® 10. HSC 117943-SQG required to register shall maintain El 26 HSC 118285-Sharps waste shall be containerized and stored treatment and shipping and tracking records for 3 years. pursuant to this section. ❑ 11. HSC 117945-SQG not required to register shall maintain ❑ 27 HSC 118295-Containers shall be washed and decontaminated information document and transportation records for 3 years. pursuant to this section. HSC 118305- Reuseable drums or conainters used for medical El 12. HSC 117960-LQG shall file MWMP with the EA. ❑ 28. waste shall not be used for other storage. ❑ 13. HSC 117975-LQG shall maintain treatment and shipping and ❑ 29 HSC 118307- Intermediate storage area shall be secured and tracking documents for 2 years. 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. ❑ 31. ❑ 16. HSC 118032-Pharmaceutical waste hauling exemption. ❑ 32. Received by: Print: Dr.Quan Nguyen Signature: Phone: 209 478-9648 Specialist: Print: Harprit Mattu,Sr REHS Signature: Phone:(209)468-3284 IF V Reinspecion on/about: A reinspection fee of$130 per hour may be charged. Page 1 of 2 EH-08/2015