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MEDICAL WASTIISPECTION REPORT Zk `1 <br /> Date: <br /> =; San Joaquin County Environmental Health Department Program <br /> pia 3 � <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: <br /> (209)468-3420 Program l <br /> 4-6 P• www.sioay.org/ehd Element: <br /> Facility Name Address City Zip Code <br /> Innovation Dental 702 porter avenue Stockton 95207 <br /> Facility Contact Title Phone Number Email Inspection Type <br /> Quan Nguyen DDS 209-478-9648 t h,AL,,jp Routine <br /> @96FyGhA I& :.� I' <br /> The above facility is inspected for compliance with Division 104,Part 14 of California Health and Safety Code(HSC). <br /> Registration Treatment <br /> ❑ HSC 117890-No LQG shall generate medical waste unless El 17. HSC 118130-All onsite medical waste treatment facilities shall <br /> 1' registered with the EA. be permitted by the EA. <br /> HSC 117950-LQG shall register with the EA prior to ❑ 18. HSC 118165-All treatment records shall be kept for 3 years. <br /> ❑ 2. generating medical waste. <br /> HSC 117903-Permit from the EA is required prior to treating ® 19 HSC 118215-All medical waste shall be treated pursuant to <br /> ❑ 3' medical waste. this section. <br /> HSC 117925-SQG that treats medical waste onsite shall HSC 118220-Pathology waste of a human nature shall be <br /> ❑ 4' <br /> register with the EA. El 20. disposed of by interment,incineration,or an approved <br /> re <br /> 9 alternative. <br /> HSC 117900-Shall not haul medical waste unless 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 /> HSC 117928-Common Storage Facility shall have permit E] 22 HSC 118225-Sharps waste shall be treated pursuant to this <br /> ❑ 6. issured by the EA. section. <br /> ❑ 7 HSC 117890-LQG shall notify EA 72 hours prior to Containment/Storage <br /> participating in temporary event. <br /> HSC 117895-SQG shall notify EA 72 hours prior to ❑ 23 HSC 117630-Biohazard bag shall meet the standards set forth <br /> ❑ 8' <br /> participating in temporary event. in this section. <br /> HSC 118275-Medical,biohazardous,sharps,trace chemo, <br /> 24 pathology,or pharmaceutical waste shall be segregated and <br /> Records/Documentation ® contained pursuant to this section. The container shall be <br /> properly labeled. <br /> HSC 118280- Biohazard bags shall be containerized and <br /> ® 9. HSC 117935-Registered SQG shall file MWMP with the EA. ® 25. stored pursuant to this section. <br /> ❑ 10 HSC 117943-SQG required to register shall maintain ❑ 26 HSC 118285-Sharps waste shall be containerized and stored <br /> treatment and shipping and tracking records for 3 years. pursuant to this section. <br /> ❑ 11. HSC 117945-SQG not required to register shall maintainrEl 27 HSC 118295-Containers shall be washed and decontaminated <br /> information document and transportation records for 3 years. pursuant to this section. <br /> HSC 118305- Reuseable drums or conainters used for medical <br /> El 12. HSC 117960-LQG shall file MWMP with the EA. 28. waste shall not be used for other storage. <br /> ❑ 13. HSC 117975-LQG shall maintain treatment and shipping and El 29 HSC 118307- Intermediate storage area shall be secured and <br /> tracking documents for 2 years. marked with proper signage. <br /> Transportation ❑ 30 HSC 118310-Designated accumulation area shall be secured <br /> p 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: �� � Signature: t Phone:209-478-9648 <br /> Specialist: Print: J Easter Signature: Phone: 209-953-7310 <br /> Reinspecion onlabout: A reinspection fee of$152 per hour may be charged. Page 1 of 3 <br /> EH-11/17 <br />