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0 <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Ave., Stockton, CA 95205 <br />(209) 468-3420 <br />MEDICAL WASTE INSPECTION FORM <br />Date T121 1- - <br />PR E)uS 000l <br />FacilityName <br />Doarc.to"\ No�;VAJ <br />FacilityAddress 525 LJ_ <br />oUU'a S-}. <br />FacilityContact <br />UN f4k Ven of s' <br />Title Noi se. £oi%em ; ori St' <br />Phone# (a01 41 -31L3 <br />-I-- <br />INSPECTION TYPE: qRoutine oComplaint []Re- nspect on <br />VIOLATION(S) <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. <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 />II-- LL 9 <br />OD +� yroumLiel' (, 1AVJ fAT I a m0 tA�1rQ rt� <br />A <br />LL <br />5tia�rcl; �cril L���eS nQi^ i nf/1i Gt7t i�nu�� `ilwmum�j'tJ' <br />L <br />5 (eke, I 54 11-14 G1A 0 1 h <br />io <br />-VIP <br />L>ti ►t 1 a <br />_5. HSC Section 117900 -Shall not haul med <br />waste unless registered or obtained LQHE. <br />_6.HSCSection 117903 -Shall not treat med <br />>> N <br />�i l��.��5%�� " I � n,& rc.lAg ult S `'1(A( (''S C1ifl �e;tVrc <br />\- ` p 1 q , <br />i f 11� fA� i fc' u (�1�AL� A ` J�-tAsKt - <br />waste without permit from enforcement agency. <br />_7.HSC Section 117908 -Common Storage <br />facility shall be registered with local enforcement <br />agency. <br />Procedures <br />/� <br />L� I t f' ��pt �t f) ' O — °�- <br />A� Un ° <br />(, ' t. yam- C u <br />_8.HSC Section 117935-SQG MWMP <br />_9.HSC Section 117943-SQG Shall keep <br />records10.HSC Section 117945-SQG not required to <br />register shall keep records for 2 years. <br />All S �t S �� }i ' �f fvi1' �gfiLlhLeL��'l(�' <br />fA MIA ', i't-o rn ra) <br />11.HSC Section 117960-LQG shall file MWMP <br />With enforcement agency. <br />S � nil 0LL 121 U) �u <br />irq io r 1 <br />_12.HSC Section 117975-LQG shall keep <br />records for 3 years. <br />Transportation <br />, S l Y .1 {1 S fl G <br />'i <br />_13. HSC Section 118030-LQHE application. <br />Treatment/Storage <br />_14.HSC Section 118135 -Shall obtain a permit <br />t�17 �1e� + &. ��' <br />from the enforcement agency to treat medical <br />waste prior to treating the waste. <br />_15.HSC Section 118765 -All treatment records <br />shall be kept for 3 years. <br />0 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 />11 <br />1 S e )-C <br />�l S� , 1 <br />VCjXj D S L ' Cly, <br />Qr lk e f <br />t) t� <br />1 S <br />(, S cz i U 1 APa <br />_18.HSC Section 118225 -Treated sharps shall <br />estroyed or somehow prevent public access. <br />9.HSC Section 118275 -MW red bags, path, <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 />j 0_ I )d 0- a9 S <br />, <br />A <br />1 ti r`� , 1 t w <br />!() I 1 n <br />LD al) <br />_23.HSC Section 118307 -Interim storage labeled(i <br />_24.HSC Section 118310 -Enclosure labeled. <br />_25.HSC Section 118305 -Cannot reuse drums <br />_26.HSC Section 117630 -Approved biohazard <br />bag used. <br />7.HSC Section 118275(g)-Pharm label/store <br />e <br />Gtt�o� <br />l <br />_28.HSC Section 118222 -Incineration Required <br />InS ctor Signature Received By Date <br />29 Other -Describe in narrative. <br />