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Environmental Health - Public
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EHD Program Facility Records by Street Name
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KNICKERBOCKER
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4500 - Medical Waste Program
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PR0536182
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COMPLIANCE INFO
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Entry Properties
Last modified
7/15/2025 3:48:44 PM
Creation date
7/3/2020 10:19:58 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4500 - Medical Waste Program
File Section
COMPLIANCE INFO
RECORD_ID
PR0536182
PE
4524 - SKILLED NURSING FACILITY
FACILITY_ID
FA0009746
FACILITY_NAME
Kindred Transitional Care and Rehabilitation Valley Gardens
STREET_NUMBER
1517
STREET_NAME
KNICKERBOCKER
STREET_TYPE
DR
City
STOCKTON
Zip
95210
APN
09056004
CURRENT_STATUS
Active, billable
QC Status
Approved
Scanner
SJGOV\cfield
Supplemental fields
FilePath
\MIGRATIONS\MW\MW_4524_PR0536182_1517 KNICKERBOCKER_.tif
Site Address
1517 KNICKERBOCKER DR STOCKTON 95210
Tags
EHD - Public
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Z015-110-30 <br />10:30 > <br />2094640138 P 2/7 <br />',,'•';•- <br />MEDICAL WAST SPECTIQiv REPORT <br />Date: <br />�p <br />1Q S <br />HSC 117950 - LOG shall register with the EA prior to <br />generating medical waste. <br />San Joaquin County Environmental Health Department <br />Program <br />L Ig <br />E <br />1868 E. Hazelton tocktonCA 95205 <br />Ave.,., , <br />(209) 468-3420 <br />HSC 117925 - SQG that treats medical waste onsite shall <br />register with the EA. <br />P <br />5, <br />HSC 117900 - Shall not haul medical waste unless registered, <br />common carrier, trauma scene practitioner, or exempted <br />under the MOT exemption. <br />❑ <br />6. <br />HSC 117928 - Common Storage Facility shall have permit <br />issured by the EA, <br />www.siogy_qr-q/ehd <br />Program <br />vlsa <br />❑ <br />8 <br />Element: <br />Facility Name <br />Address <br />City <br />Zip Code <br />Valley Gardens Healthcare and Rehabilitation 1517 knickerbocker dr. <br />Stockton <br />95210 <br />Facility Contact <br />Title Phone Number <br />Email <br />Inspection Type <br />Lewis Galvan <br />Maintenance Supervisor (209) 957-4539 <br />❑ <br />Routine <br />The above facility is inspected for compliance with Division 104, Part 14 of California Health and Safety Code (HSC) <br />Print: <br />nature: <br />Registration <br />❑ <br />1 <br />HSC 117890 - No LOG shall generate medical waste unless <br />registered with the EA. <br />❑ <br />2 <br />HSC 117950 - LOG shall register with the EA prior to <br />generating medical waste. <br />® <br />3 <br />NSC 117903 - Permit from the EA is required priorto treating <br />medical waste, <br />❑ <br />4 <br />HSC 117925 - SQG that treats medical waste onsite shall <br />register with the EA. <br />❑ <br />5, <br />HSC 117900 - Shall not haul medical waste unless registered, <br />common carrier, trauma scene practitioner, or exempted <br />under the MOT exemption. <br />❑ <br />6. <br />HSC 117928 - Common Storage Facility shall have permit <br />issured by the EA, <br />® <br />7 <br />HSC 117890 - LOG shall notify EA 72 hours prior to <br />participating in temporary event. <br />❑ <br />8 <br />HSC 117895 - SQG shall notify EA 72 hours prior to <br />Participating in temporary event. <br />Records/Documentation <br />❑ <br />9. <br />HSC 117935 - Registered SQG shall file MWMP with the EA. <br />Q <br />10. <br />NSC 117943 - SQG required to register shall maintain <br />treatment and shipping and tracking records for 3 years. <br />❑ <br />11 <br />HSC 117945 - SQG not required to register shall maintain <br />information document and transportation records for 3 years. <br />® <br />12. <br />HSC 117960 - LQG shall file MWMP with the EA. <br />❑ <br />13. <br />HSC 117975 - LOG shall maintain treatment and shipping and <br />tracking documents for 2 years. <br />❑ <br />Transportation <br />❑ <br />14. <br />HSC 117946 - MOT exemption requirements for SQG. <br />❑ <br />15, <br />MSC 117976 - MOT exemption requirements for LOG. <br />❑ <br />16. <br />HSC 118032 - Phamlaceutical waste hauling exemption, <br />Print: <br />nature: <br />468-3178 <br />Reinspecion on/about: A reinspection fee of $130 per hour may be charged. <br />EH -08/2015 Page 'I of 2 <br />Received Time Oct,30. 2015 10:36AM No,9905 <br />Treatment <br />❑ <br />17 <br />HSC 118130 -All onsite medical waste treatment facilities shall <br />be permitted by the EA, <br />❑ <br />18. <br />HSC 116165 -All treatment records shall be kept for 3 years. <br />® <br />19 <br />HSC 118215 - All medical waste shall be treated pursuant to <br />this section. <br />NSC 118220 - Pathology waste of a human nature shall be <br />❑ <br />20. <br />disposed of by interment, incineration, or an approved <br />alternative, <br />HSC 118222 - Contaminated pathology waste, trace chemo <br />❑ <br />21- <br />waste, or pharm waste from health care settings shall be treated <br />ineration or an a roved alternative. <br />® <br />�HSC 118225 - Sharps waste shall be treated pursuant to this <br />n. <br />Containment/Storage <br />❑ <br />23 <br />HSC 117630 - Biohazard bag shall meet the standards set forth <br />in this section, <br />HSC 118275 - Medical, biohazardous, sharps, trace chemo, <br />24 <br />pathology, or pharmaceutical waste shall be segregated and <br />contained pursuant to this section. The container shall be <br />properly labeled. <br />® <br />25 <br />HSC 11$280 - Biohazard bags shall be containerized and <br />stored pursuant to this section. <br />® <br />26, <br />HSC 118285 - Sharps waste shall be containerized and stored <br />pursuant to this section. <br />❑ <br />27. <br />HSC 118295 - Containers shall be washed and decontaminated <br />pursuant to this section, <br />® <br />28 <br />HSC 118305 - Reuseable drums or conainters used for medical <br />waste shall not be used for other storage. <br />❑ <br />29 <br />HSC 118307- Intermediate storage area shall be secured and <br />marked with proper signage. <br />❑ <br />30, <br />HSC 118310 - Designated accumulation area shall be secured <br />and marked with proper signage. <br />Other <br />❑ <br />31. <br />❑ <br />32. <br />468-3178 <br />Reinspecion on/about: A reinspection fee of $130 per hour may be charged. <br />EH -08/2015 Page 'I of 2 <br />Received Time Oct,30. 2015 10:36AM No,9905 <br />
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