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SAN JOAQUIN COUNTY Date wt-keliq <br /> ENVIRONMENTAL HEALTH DEPARTMENT PR 0,; 13 <br /> 1868 East Hazelton Ave., Stockton, CA 95205 <br /> (209)468-3420 <br /> A�tF... MEDICAL WASTE INSPECTION FORM <br /> 0 <br /> FacilityName ivr, tkfw-nVe, —FacilityAddress A,,,-- <br /> 0 n1l yAA) Title <br /> FacilityContact .Phone4,aa�$3S�—SUS_ <br /> INSPECTION TYPE: PRoutine []Complaint EiRe-inspection <br /> VIOLATION(S) <br /> Registration THE ITEMS BELOW REPRESENT VIOLATIONS OF THE CALIFORNIA <br /> --1.HSC Section 117955-Large Quantity HEALTH & SAFETY CODE (HSC): <br /> -denerator shall register with the enforcement <br /> agency prior to commencement of the generation o <br /> medical waste. o v sAA1 fin &I <br /> 2.HSG Section 117903-Permit from the <br /> enforcement agency required to treat medical <br /> waste. CLAth Lin <br /> —3.HSG 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 (,,A 00, 1'S4%VX, ti- <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 1117903-Shall not treat med FtA.jk kh2tPV1\ A (CA'W(A <br /> waste without permit from enforcement agency. <br /> THSC Section 117908-Common Storage slnv")Ov <br /> A',A io �Vj <br /> facility shall be registered with local enforcement f'A tA, <br /> agency. <br /> Procedures t fy-)(A AW j\ to) st)A <br /> 8.HSC Section 117935-SQG MVVMP <br /> —9.HSC Section 117943-SQG Shall keep <br /> records for 3 years. <br /> —10.HSG Section 117945-SQG not required to <br /> register shall keep records for 2 years. <br /> -j <br /> I I.HSC Section 117960-LQG shall file MWMP �k I rf)Lk L6�y tAl LkM S�C <br /> with enforcement agency. <br /> —12.HSC Section 117975-LQG shall keep �,knsw(- (A-A it)-y Ajc-(A�yd --Lkias SaW LA� <br /> records for 3 years. <br /> Transportation QAA-,. PACA% -,A \.AJ(A!, )1-1�111AL�LA +-0 <br /> 13.HSC Section 118030-LQHE application. 1) - <br /> T— L <br /> reatmentisto rage WAC'k tv�L kw�f r.%'flA -N nA OiA <br /> —14.HSC Section 118135-Shall obtain a permit X4VVJ'Q- -�N QV)WMCktAXXV CA <br /> from the enforcement agency to treat medical <br /> waste prior to treating the waste. h C A� <br /> —15.HSC Section 118765-All treatment records <br /> shall be kept for 3 years. <br /> 16.HSC Section 118215-All medical waste <br /> shall be treated pursuant to this section. <br /> --ITHSC Section 118220-Recognizable human <br /> anatomical parts shall be disposed of by interment <br /> unless otherwise hazardous. <br /> 18.1-11SC Section 118225-Treated sharps shall <br /> bedestroyedor somehow prevent public access. <br /> --19.HSC Section 118276-MW red bags,path, <br /> chemo shall be labeled properly. <br /> 20.HSC Section 118280-MW label&contain <br /> —21.HSG Section 118285-Sharps label/contain <br /> 22.HSC Section 118295-Proper decon used. <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 Section 117630-Approved biohazard <br /> bag used. <br /> —27.HSC Section 118275(g)-Pharm labellstore <br /> —28.HSC Section 118222-Incineration Required Inspe&br Signature Received By Date <br /> 29 Other-Describe in narrative. <br />