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10/10/2012 18:04 <br />2094770522 WINDSOR ELMHAVEN CAR <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202 <br />(209) 468-3420 <br />MEDICAL WASTE INSPECTION FORM <br />PAGE 03/05 <br />i r 4 <br />5 <br />-�6FacifityAddressI <br />Faci1ItyC` r <br />• / I Jul t /—Phone# <br />.r17 <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 r!or o commencement of the aeneration__of <br />medical waste. <br />_2.HSCSection117903-Permit from the <br />enforcement agency required to treat medical <br />waste. <br />—3. HSC Section 117890 -No large LOG shall <br />generate medical waste unless registered with the <br />enforcement agency, <br />+r <br />' <br />_4. NSC Section 117895-SQG that treats med <br />waste shall register with enforcement agency. <br />_5. HSC Section 117900 -Shall not haul mod <br />waste unless registered or obtained LQHE. <br />6.HSC Section 117903 -Shall not treat med <br />(+ <br />4 )r. I rr'_... Gdi 14j". to ) <br />4 <br />waste without permit from enforcement agency. <br />_THSC Section 117908 -Common Storage <br />facility shall be registered with local enforcement <br />agency. <br />Procedures <br />+ <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 />\ II <br />register shall keep records for 2 years. <br />II <br />L1 <br />_11.HSC Section 117960-LQG shall file MWMP <br />with enforcement agency, <br />12.HSC Section 117975-LQG shall keep <br />A <br />�%— <br />reoords for 3 years. <br /><<'CG=xi�,-=-.�= - <br />- <br />Transportation <br />_ <br />_13. HSC Section 118030-LQHE application. <br />Treatment/Storage <br />14.HSC Section 118136 -Shall obtain a permit <br />from the enforcement agency to treat medical <br />waste prior tore�ting the waste. <br />Ti <br />sr <br />_15,HSC Section 118765 -Ail treatment records <br />shall be kept for 3 years. <br />1 r✓1�/l� �) � <br />_16. treated <br />Section pursuant this 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 118226 -Treated sharps sha11 <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 />r-21.HSC Section 118285 -Sharps label/contain <br />_22.HSC Section 118296 -Proper decon used. <br />_23.HSC Section 118307 -Interim storage labeled <br />_24.HSC Section 118310 -Enclosure labeled. <br />25.HSC Section 118306 -Cannot reuse drums <br />^26.HSC <br />! <br />Section 117830 -approved biohazard <br />bog used. <br />14 --•/a <br />_27.HSC Section 118275(g) -Pharr» label/stare f <br />_28.HSC Section 118222 -Incineration Required <br />29 Other-Descrlbe in narrative. <br />.� Cto ;, ignature / Rece y Date <br />Received Time Oct,11, 2012 7:46AM No,0297 <br />