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0 0 <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202 <br />(209) 468-3420 <br />MEDICAL WASTE INSPECTION FORM <br />FracilityName , FacilityAddress5225 W. , <br />FacilitylConlDcokt r on <br />�7 <br />Date_ u� ) 11 <br />PR 040u01 <br />Registration <br />THE ITEMS BELOW REPRESENT VIOLATIONS OF THE CALIFORNIA <br />_ 1. HSC Section 117955 -Large Quantity <br />Generator shall register with the enforcement <br />HEALTH & SAFETY CODE (HSC): <br />agency prior to commencement of the generation of <br />medical waste.U <br />_2. HSC Section 117903 -Permit from the <br />enforcement agency required to treat medical <br />waste. <br />_3. HSC Section 117890 -No large LQG shall <br />generate medical waste unless registered with the. <br />enforcement agency. <br />_4. HSC Section 117895-SQG that treats med <br />waste shall register with enforcement agency. <br />_5. HSC Section 117900 -Shall not haul med <br />waste unless registered or obtained LQHE. <br />_6.HSC Section 117903 -Shall not treat med <br />1c f <br />a i '4LftAkS <br />1 <br />e.Sovtj loo %] 1 m ,t1 <br />�` <br />(� VJ tS� . �. � <br />' <br />t , .Q. �A- (, n �1`a�u Lt7i?M, �IIJU {�iJ►I TcSU1/at (,c. <br />` <br />(U<) rte 5l0 e S p Sits S'}s��^I $4t <br />waste without permit from enforcement agency. <br />_7.HSCSection 117908 -Common Storage <br />facility shall be registered with local enforcement <br />agency. <br />Procedures <br />t� O\d tc t 4L 1•v� St)t) <br />, ik ( ® `�� j on <br />_8.HSC Section 117935-SQG MWMP <br />_9.HSC Section 117943-SQG Shall keep <br />records for 3 years. <br />_10.HSC Section 117945-SQG not required to <br />register shall keep records for 2 years. <br />_11.HSC Section 117960-LQG shall file MWMP <br />with enforcement agency. <br />_12.HSC Section 117975-LQG shall keep <br />records for 3 years. <br />0 1 <br />'d tit, tit S 'Y1 ilv- b1�0 , atl5 <br />!0 a r1 t1.J S hit <br />l <br />W �, hW csS y' of 1,iliJ�la1� <br />�` 1 ' U Si S • <br />i s coil Si <br />Transportation <br />_13. HSC Section 118030-LQHE application. <br />Treatment/Stora e <br />Section 118135 -Shall obtain a permit <br />From <br />from the enforcement agency to treat medical{ <br />waste prior to treating the waste. <br />' CAI WC&4T� M Q 11 <br />``_� <br />�� a CJS Ll, [JY� nNA.A, In <br />l <br />` t WAi'\ <br />_15.HSC Section 118765 -All treatment records <br />shall be kept for 3 years. <br />1 C <br />_16.HSC Section 118215 -All medical waste <br />shall be treated pursuant to this section. <br />_17.HSC Section 118220 -Recognizable human <br />anatomical parts shall be disposed of by interment <br />unless otherwise hazardous. <br />_18.HSC Section 118225 -Treated sharps shalll <br />be destroyed or somehow prevent public access. <br />19.HSC Section 118275 -MW red bags, path, <br />'1 <br />®t-IN'J �i n C D ' <br />_ y <br />�� Y& t <br />chemo shall be labeled properly. <br />.�,_20.HSC Section 118280 -MW label & contain <br />_21.HSC Section 118285 -Sharps label/contain <br />_22.HSC Section 118295 -Proper decon used. <br />-K23.HSC Section 118307 -interim storage labeled <br />Section 118310 -Enclosure labeled. <br />�11 <br />'g _ W C j �i ltJ <br />Y�+L° �(kS W ( ;'� f� L . <br />t, <br />S� Svi u�i 11� M <br />_24.HSC <br />_25.HSC Section 118305 -Cannot reuse drums <br />_26.HSC Section 117630 -Approved biohazard <br />- <br />bag used. <br />_27.HSC Section 118275(g)-Phann labellstore <br />�_ —YA/ <br />InspeC r Signature eived F3j Dat <br />_28.HSC Section 118222 -Incineration Required <br />29 Other -Describe in narrative. <br />