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SAN JOAQUIN COUNTY Date to(Zc%lo <br />ENVIRONMENTAL HEALTH DEPARTMENT PR 4S0iit, <br />600 East Main Street, Stockton, CA 95202 <br />(209) 468-3420 <br />MEDICAL WASTE INSPECTION FORM <br />Facility Name Raise/ Facility Address lf32t3 W ea -t I arna, ShCA:-h:nn <br />Facility Contact ,na- M e sa e- Titlegf,2{-,, (fie✓ Phone # $ ZS - 317 4-12 <br />INSPECTION TYPE: Moutine <br />❑Complaint <br />VIOLATION(S) <br />❑Reinspection <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 />�,�. ,, �, <br />n o 1el(6.0 icnis nc&r � -kM� I. A _ I ao�Adv�, - <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 />_ <br />_6.HSC Section 117903 -Shall not treat med <br />` <br />waste without permit from enforcement agency. <br />- <br />_7.HSC Section 117908 -Common Storage <br />facility shall be registered with local enforcement <br />agency. <br />Procedures <br />e , <br />- <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 />n _ <br />register shall keep records for 2 years. <br />y (yp_ �CYk,,A .�,- 1 ✓lI"`� .- j2n fi i C. C <br />11.HSC Section 117960-LQG shall file MWMP <br />r <br />with enforcement agency. <br />_,, -- <br />yi . . �.,.�_ n `1nj4 1i i /2 .,AGA I l: r.Pr, CA-' <br />t, 1 <br />10-0 <br />_12.HSC Section 117975-LQG shall keep <br />records for 3 years. <br />�' ll �CT�ll�1�_`� -, ^ 1 r � "j`^--- ^ Q <br />�. �'a � 1l � � �� <br />Transportation <br />_13. HSC Section 118030-LQHE application. <br />Treatment/Storage <br />_14.HSC Section 118135 -Shall obtain a permit <br />From the enforcement agency to treat medical <br />waste prior to treating the waste. <br />_15.HSC Section 11 8765 -All treatment records <br />shall be kept for 3 years. <br />_16.HSC Section 118215 -All medical waste shall <br />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 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 <br />_21.HSC Section 118285 -Sharps label/contain <br />_22.HSC Section 118295 -Proper decon used. <br />_23.HSC Section 118310 -Enclosure labeled. <br />24.HSC Section 118305 -Cannot reuse drums <br />_25.HSC Section 117630 -Approved biohazard <br />bag used. <br />_26.HSC Section 118275 (g) Pharm label/store <br />27.HSC Section 118222 Incineration Only <br />0(01-4<k a} <br />Treatment <br />28. Other -Describe in narrative. <br />Inspe for 8 flbnatur Received By Date <br />