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SAN JOAQUIN COUNTY Dated(I(p I!A <br /> ENVIRONMENTAL HEALTH DEPARTMENT PR C)S24 SaA, <br /> A 1868 East Hazelton Ave., Stockton, CA 95205 <br /> (209)468-3420 <br /> MEDICAL WASTE INSPECTION FORM <br /> FacilityName FacilityAddress_RI&I, <br /> FacilityContact Tonle., bNntANA) TitleCICS _5 <br /> P h o n e#kA)ZZS <br /> INSPECTION TYPE: Moutine []Complaint EiRe-inspection <br /> VIOLATION(S) <br /> Registration THE ITEMS BELOW REPRESENT VIOLATIONS OF THE CALIFORNIA <br /> -1.HSC Section 117965-Large Quantity HEALTH &SAFETY CODE (HSC): <br /> -denerator shall register with the enforcement <br /> agency prior to commencement of the generation of <br /> medical waste. �)ID \)�0\&kianc- <br /> 2.HSC Section 117903-Permit from the <br /> enforcement agency required to treat medical <br /> waste. <br /> 3.HSC Section 117890-No large LQG shall <br /> P'64AA I Q r-A- of,I CnA C'I'k <br /> generate medical waste unless registered with the <br /> enforcement agency. <br /> 4.HSC Section 117895-SQG that treats medri IAS of- <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 3. Ttue),A,. <br /> waste without permit from enforcement agency. \A 0 <br /> THSC Section 117908-Common Storage (19-a 0 1 t"W? La� W05 Ak <br /> facility shall be registered with local enforcement <br /> agency. <br /> Procedures Dk(A"--\ -f R-SQ014I)a <br /> 8.HSC Section 11 7935-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. Auv)MNA <br /> 11.HSC Section 117960-LQG shall file MVVMP <br /> �ith enforcement agency. (:�)SIM +/A <br /> —12.HSC Section 117975-LQG shall keep G ("�-fYtVY- <br /> records for 3 years. - <br /> Transportation Cl' Lks IJP <br /> —13.HSG Section 11 8030-LQHE application. \.n <br /> TreatmenUSto rage (n nlrLil- ty\\R ,�A U."A� 6t yi r) (2 <br /> —14.HSC Section 118135-Shall obtain a permit WMS�e, <br /> from the enforcement agency to treat medical <br /> waste prior to treating the waste. 4ur' A A Ru' : <br /> 15.HSC Section 118765-Ail treatment records <br /> -P <br /> shall be kept for 3 years. YrKA,)mW, QuA e <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 /> 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 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 label/store RW <br /> 28.HSC Section 118222-Incineration Required I Tnsi for r ignature Received By Date <br /> 29 Other-Describe in narrative. <br />