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El <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 D <br />PR Ott ()I)4l <br />FacilityName p� vn 1�vsnl�r�' FacilityAddress 51S W. A,,tin <br />FacilityContact UA#� �n>,,1&f Title UuiSg., Phone <br />INSPECTION TYPE: ARPtioutine <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.C�`, <br />_2. HSC Section 117903 -Permit from the <br />enforcement agency required to treat medical <br />noW <br />$S �_ 4� Jew r)'X0 <br />l <br />� <br />waste. <br />_3. HSC Section 117890 -No large LQG shall <br />LAP s6roa <br />T'00' fTl ; <br />generate medical waste unless registered with the <br />enforcement agency.1 <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 />An <br />waste unless registered or obtained LQHE. <br />_6.11SC Section 117903 -Shall not treat med <br />waste without permit from enforcement agency. <br />_7.11SC Section 117908 -Common Storage <br />facility shall be registered with local enforcement <br />agency. <br />Procedures <br />�► �U• <br />Ul'1 , G'�' <br />t� 1T r W <br />' <br />i 5 aE <br />U l nem. S Q_R l <br />g,—' a(S <br />, �� <br />_8.11SC Section 117935-SQG MWMP1 <br />_9. HSC Section 117943-SQG Shall keep <br />records for 3 years.C <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 />records for 3 years.n 117975 LQG shall keep <br />Transportation <br />_13. HSC Section 118030-LQHE application. <br />j "�''5WL411dj <br />I 1j <br />} �,r S <br />i „ <br />UJ <br />U ,� <br />UP <br />t tk � 2. US ) <br />3's <br />AnS <br />s C }- i'nV- <br />Treatment/Storage <br />_14.11SC Section 118135 -Shall obtain a permit <br />L, <br />From the enforcement agency to treat medical� <br />waste prior to treating the waste. <br />v t! S <br />0 1 tti� <br />J`n <br />�l <br />1(� <br />_15.HSC Section 11 8765 -All treatment records <br />shall be kept for 3 years. <br />' <br />.l Q . uI Aldfill, <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 />CUn <br />t� <br />_ <br />_18.HSC Section 118225 -Treated sharps shall <br />be destroyed or somehow prevent public access. <br />_19.HSC Section 118275 -MW red bags, path, <br />chemo shall be labeled properly. <br />_20.HSC Section 118280 -MW label & contain-21.HSC <br />Section 118285 -Sharps label/contain <br />_22.HSC Section 118295 -Proper decon used. <br />5 ` 11, 1114 1 l i4y <br />L4 S <br />N <br />' muff)?' i's <br />`U <br />_23.HSC Section 118307 -Interim storage labeled <br />_24.HSC Section 118310 -Enclosure labeled. <br />25.HSC Section 118305 -Cannot reuse drums <br />—26.HSC <br />Section 117630 -Approved biohazard <br />bag used. <br />Lb► <br />27.HSC Section 118275(g)-Pharm label/store <br />Inspe or Signature <br />Received By <br />Date <br />_28.HSC Section 118222 -Incineration Required <br />29 Other -Describe in narrative. <br />