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MEDICAL WASTE INSPECTION REPORT Date: February 23,2023 San Joaquin County Environmental Health Department Program 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: PRO546503 c P/ (209)468-3420 Program www.siogv.org/ehd Element: 4530 Facility Name Address City Zip Code Davita Grant Line Dialysis 2955 N Corral Hollow Rd.Ste 101 Tracy 95376 Facility Contact Title Phone Number Email Inspection Type Courtney Vela Facility Administrator 209-839-8302 Routine 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 1' registered with the EA. ❑ 17' be permitted by the EA. ❑ HSC 117950-LQG shall register with the EA prior to 2' generating medical waste. El18. HSC 118165 All treatment records shall be kept for 3 years. ❑ HSC 117903-Permit from the EA is required prior to treating HSC 118215-All medical waste shall be treated pursuant to 3' medical waste. El 19. 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. ❑ HSC 117928-Common Storage Facility shall have permit HSC 118225-Sharps waste shall be treated pursuant to this 6' issured by the EA. ❑ 22' section. ❑ 7 HSC 117890-LQG shall notify EA 72 hours prior to 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 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. HSC 118280-Biohazard bags shall be containerized and stored El 9. HSC 117935 Registered SQG shall file MWMP with the EA. ® 25. pursuant to this section ❑ HSC 117943-SQG required to register shall maintain HSC 118285-Sharps waste shall be containerized and stored 10. 26 treatment and tracking records for 3 years. ❑ ' pursuant to this section. HSC 117945-SQG not required to register shall maintain HSC 118295-Containers shall be washed and decontaminated El 11. information document and USPS records for 3 years. El 27' pursuant to this section. ❑ 12. HSC 117960-LQG shall file MWMP with the EA. ❑ 28 HSC 118305-Reusabla drums or containers used for medical waste shall not be usec for other storage. HSC 117975-L 29 LQG shall maintain treatment and tracking HSC 118307-Intermed ate storage area shall be secured and ® 13. documents for 2 years. ❑ ' marked with proper signage. Transportation ® 30. HSC 118310-Designated accumulation area shall be secured and marked with prope-signage. ❑ 14. HSC 117946-MOT exemption requirements for SQG. Other ❑ 15. HSC 117976-MOT exemption requirements for LQG. ® 31. HSC 117630—Secondary container ❑ 16. HSC 118032-Pharmaceutical waste hauling exemption. ❑ 32. Received by: Print: Courtney Vela Signature: EMAILED Phone:209-839-8302 Specialist: Print: Sandip Singh Signature: L�2�L4 Lr� Phone:209-468-3526 Reinspecion on/about: A reinspection fee of$156 per hour may be charged. Page 1 of 3 EH-2/2023