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i <br />Date <br />• Record I DM L4500 I S <br />Prog Elem �i• 2�-f <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 />Facility Nam)c��n. Facility Address I 7 �� l �f`Amci e - <br />Facility Contact VYl(1 <br />OZ �Tt Titleb��, Rk t LAS' nci Phone # 143L 3 '2 <br />INSPECTION TYPE: IMoutine <br />Registration <br />1. HSC Section 117955 -Large Quantity <br />G_enerator shall register with the enforcement <br />agency prior to commencement of the generation <br />of medical waste. <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 />generate medical waste unless registered with <br />the 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 />_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 />8.HSC Section 117935-SQG MWMP <br />_9.HSC Section 117943-SQG Shall keep <br />records for 3 years. <br />—1 O.HSC Section 117945-SQG not required to <br />re16ter shall keep records for 2 years. <br />i/ 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 11 8765 -All treatment <br />records shall be kept for 3 years. <br />16.HSC Section 11 8215 -All medical waste <br />sh_all be treated pursuant to this section. <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 />25.HSC Section 117630 -Approved biohazard <br />ba–g used. <br />26. Other -Describe in narrative. <br />❑Complaint <br />VIOLATION(S) <br />❑Reinspection <br />THE ITEMS BELOW REPRESENT VIOLATIONS OF THE CALIFORNIA <br />HEALTH & SAFETY CODE (HSC): <br />Z <br />