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C� <br />• <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />304 E. Weber Ave., Third Floor, Stockton, CA 95202 <br />(209) 468-3420 <br />MEDICAL WASTE INSPECTION FORM <br />Date <br />Record I D 4 at rip <br />Prog Elem___qC_-2�0 <br />Facility Name e. N v -=a T -n Facility Address 5- <br />Facility Contacto Title Phone # <br />INSPECTION TYPE: �Poutine ❑Complaint ❑Reinspection <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 <br />of medical waste. <br />2. HSC Section 117903 -Permit from the <br />cement agency required to treat medical <br />Q I'lID� ����4k �/11�� jsCn <br />wast <br />_3. HSC Section 117890 -No large LQG shall <br />generate medical waste unless registered with <br />the enforcement agency. <br />_4. NSC 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 />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 />B.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 <br />MWMP with enforcement agency. <br />_12.HSC Section 117975-LQG shall keep <br />records for 3 years. <br />Transportation <br />_13. HSC Section 118030-LQHE application. <br />Treatment/Storage , <br />_14.HSC Section 118135 -Shall obtain a <br />permit from the enforcement agency to treat <br />medical waste prior to treating the waste. <br />_15.HSC Section 118765 -All treatment <br />records shall be kept for 3 years. <br />_16.HSC Section 118215 -All medical waste <br />shall be treated pursuant to this section. <br />' <br />_17.HSC Section 118220 -Recognizable <br />human anatomical parts shall be disposed of by <br />interment 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 />/ <br />_25.HSC Section 117630 -Approved biohazard <br />bag used. <br />r ,, ���� <br />4nsct <br />—26. Other -Describe in narrative. <br />X(I�,� <br />.. <br />r Signa ure Received By <br />