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AM <br /> ® 4!!►N, o SAN JOAQUIN COUNTY Ir Date al1,7I3 <br /> ENVIRONMENTAL HEALTH DEPARTMENT PR a53Io115t <br /> 2� 1868 East Hazelton Ave., Stockton, CA 95205 <br /> (209)468-3420 <br /> q�tFORr'`P MEDICAL WASTE INSPECTION FORM <br /> FacilityNameAmbv�ki,�bru 'Swggtx of FacilityAddress 93S% Si- <br /> FacilityContact �i Uk4 ew a Title Af�rm;[\'i 36-�"r Phone# CIMU4 - <br /> INSPECTION TYPE: outine ❑Complaint ❑Re-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 /> Generator shall register with the enforcement <br /> agency prior to commencement of the generation of <br /> medical waste. ' 1 i <br /> _2.HSC Section 117903-Permit from the -T 10 U?Q, n 17 \110�G �n nfl <br /> enforcement agency required to treat medical Y l <br /> waste. <br /> HSC Section 117890-No large LQG shall 1 GN <br /> generate medical waste unless registered with the US I1UZ'1 l (� I CC l Q.vt� <br /> enforcement agency. t <br /> 4.HSC Section 117895-SQG that treats med <br /> waste shall register with enforcement agency. p <br /> _5.HSC Section 117900-Shall not haul med 'Q , Fh�tlj V LL ' 1r s 'r rS�► <br /> waste unless registered or obtained LQHE. 1_ <br /> _6.HSC Section 117903-Shall not treat med <br /> waste without permit from enforcement agency. <br /> Facility <br /> Section 117908-Common Storage <br /> facility shall be registered with local enforcement 3, S 1npl rs J, V�.t., Ah <br /> agency. <br /> Procedures rC 4N <br /> 8.HSC Section 117935-SQG MWMP <br /> _9.HSC Section 117943-SQG Shall keep I. <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 MWMP / <br /> with enforcement agency. 6114-1A h axr-, <br /> _12.HSC Section 117975-LQG shall keep ' t �1�3e 'CA <br /> records for 3 years. <br /> Transportation ►Nk4 -tom n �. Z2 1Z 1L 23 lZ <br /> _13.HSC Section 118030-LQHE application. <br /> Treatment/Storage 'W, 117A 150 oZjQj_— <br /> _14.HSC Section 118135-Shall obtain a permit " ,f l <br /> From the enforcement agency to treat medical \ _ _ t } s� <br /> waste prior to treating the waste. Voll CA Y u <br /> _15.HSC Section 118765-All treatment records <br /> shall be kept for 3 years. I, <br /> _16.HSC Section 118215-All medical waste CA tk�(� <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 J <br /> bag used. <br /> _27.HSC Section 118275(g)-Pharm label/store <br /> 28.HSC Section 118222-Incineration Required InS for Signature eceived By ate <br /> 29 Other-Describe in narrative. <br />