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A SAN JOAQUIN COUNTY Date) ;-)3 It <br />E RONMENTAL HEALTH DEPARTMS PR SIJ <br />600 East Main Street, Stockton, CA 95202 <br />(209) 468-3420 <br />MEDICAL WASTE INSPECTION FORM <br />FacilityName��s 1"lerncn-),>,, I t0&( FacilityAddress 01-s>-mcmf <br />FacilityContact r7m V Y1i? Title` dv Phone# <br />INSPECTION TYPE: Routine ❑Complaint ❑Re -inspection <br />VIOLATION(S) <br />Registration <br />THE ITEMS BELOW REPRESENT VIOLATIONS OF THE CALIFORNIA <br />_ 1. HSC Section 117955 -Large Quantity <br />HEALTH & SAFETY CODE (HSC): <br />Generator shall register with the enforcement <br />agency prior to commencement of the generation of <br />medical waste. <br />_ <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 />-'� <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 />Section 117903 -Shall not treat med <br />{� <br />"' T'T —c. r <br />_6.HSC <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 />(A Al NA- TY�&} <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 />register shall keep records for 2 years.- <br />_ <br />11.HSC Section 117960-LQG shall file MWMP <br />witX4enforcement agency. <br />I.--.(' <br />Of1 <br />ti <br />2.HSC Section 117975-LQG shall keep <br />records for 3 years. <br />Transportation <br />' <br />_13. HSC Section 118030-LQHE application. <br />Treatment/Sto rage <br />_14.HSC Section 118135 -Shall obtain a permit <br />- <br />from the enforcement agency to treat medical <br />waste prior to treating the waste. <br />, <br />15.HSC Section 118765 -All treatment records <br />sh_all be kept for 3 years. <br />_16.HSC Section 118215 -All medical waste <br />shall be treated pursuant to this section. <br />_17.HSC Section 118220 -Recognizable human <br />/�1 <br />riT ►� e- �� �'1 /' )A <br />anatomical parts shall be disposed of by interment <br />unless otherwise hazardous. <br />C). VV" .J V' `4�L1' j/& --"C) Girl t c � t-x� <br />_18.HSC Section 118225 -Treated sharps shall <br />be destroyed or somehow prevent public access._gl <br />9.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 />S G <br />:Z23.HSC Section 118307 -Interim storage labeled <br />_24.HSC Section 118310 -Enclosure labeled. <br />Section 118305 -Cannot reuse drums <br />_25.HSC <br />_26.HSC Section 117630 -Approved biohazard <br />ba`g2used. <br />7.HSC Section 118275(g)-Pharm label/store <br />s ` <br />f <br />_28.HSC Section 118222 -Incineration Required <br />etor Signature Rec d By Date <br />29 Other -Describe in narrative. <br />�3� <br />