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Facility Name Address City Zip Code <br />Valley Gardens Healthcare and Rehabilitation 1517 knickerbocker dr. Stockton 95210 <br />Facility Contact Title Phone Number Email Inspection Type <br />Karol Ford Director (209) 957-4539 Routine <br />The above facility is inspected for compliance with Division 104, Part 14 of California Health and Safety Code (HSC). <br />MEDICAL WAST&SPECTION REPORT <br />1 LSan <br />Treatment <br />❑ <br />Date: <br />HSC 117890 - No LQG shall generate medical waste unless <br />om_'O�' <br />Joaquin County Environmental Health Department <br />Program1868 <br />E. Hazelton Ave., Stockton, CA 95205Record:(209)468-3420 <br />www.siogv.org/ehd <br />Program�;io6`d <br />Element: <br />2' <br />HSC 117950 - LQG shall register with the EA prior to <br />Facility Name Address City Zip Code <br />Valley Gardens Healthcare and Rehabilitation 1517 knickerbocker dr. Stockton 95210 <br />Facility Contact Title Phone Number Email Inspection Type <br />Karol Ford Director (209) 957-4539 Routine <br />The above facility is inspected for compliance with Division 104, Part 14 of California Health and Safety Code (HSC). <br />Received by: Print: Karol <br />Specialist: Print: Benje <br />Sr REHS <br />r <br />n �1 <br />L Phone: 20 qs TS <br />tNYVk^, , Phone: (209) 468-3178 I <br />Reinspecion on/about: A reinspection fee of $130 per hour may be charged. Page 1 of 2 <br />EH -08/2015 <br />Registration <br />Treatment <br />❑ <br />1' <br />HSC 117890 - No LQG shall generate medical waste unless <br />El <br />17' <br />HSC 118130 -All onsite medical waste treatment facilities shall <br />registered with the EA. <br />be permitted by the EA. <br />E] <br />2' <br />HSC 117950 - LQG shall register with the EA prior to <br />El18. <br />HSC 118765 -All treatment records shall be kept for 3 years. <br />generating medical waste. <br />❑ <br />3. <br />HSC 117903 - Permit from the EA is required prior to treating <br />El <br />1g' <br />HSC 118215 - All medical waste shall be treated pursuant to <br />medical waste. <br />this section. <br />❑ <br />4. <br />HSC 117925 - SQG that treats medical waste onsite shall <br />❑ <br />20. <br />HSC 118220 - Pathology waste of a human nature shall be <br />disposed incineration, <br />register with the EA. <br />of by interment, or an approved <br />alternative. <br />HSC 117900 - Shall not haul medical waste unless registered, <br />HSC 118222 - Contaminated pathology waste, trace chemo <br />❑ <br />5. <br />common carrier, trauma scene practitioner, or exempted <br />❑ <br />21. <br />waste, or pharm waste from health care settings shall be treated <br />under the MOT exemption. <br />by incineration or an approved alternative. <br />❑ <br />6 <br />HSC 117928 - Common Storage Facility shall have permit <br />❑ <br />22 <br />HSC 118225 - Sharps waste shall be treated pursuant to this <br />issured by the EA. <br />section. <br />❑ <br />7. <br />HSC 117890 - LQG shall notify EA 72 hours prior to <br />Containment/Storage <br />participating in temporary event. <br />8' <br />HSC 117895 - SQG shall notify EA 72 hours prior to❑ <br />® <br />23. <br />HSC 117630 - Biohazard bag shall meet the standards set forth <br />participating in temporary event. <br />in this section. <br />HSC 118275 - Medical, biohazardous, sharps, trace chemo, <br />Records/Documentation <br />® <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 />9. <br />HSC 117935 - Registered SQG shall file MWMP with the EA. <br />❑ <br />25 <br />HSC 118280 - Biohazard bags shall be containerized and <br />stored pursuant to this section. <br />❑ <br />10. <br />HSC 117943 - SQG required to register shall maintain <br />❑ <br />26 <br />HSC 118285 - Sharps waste shall be containerized and stored <br />treatment and shipping and tracking records for 3 years. <br />pursuant to this section. <br />❑ <br />11. <br />HSC 117945 - SQG not required to register shall maintain <br />❑ <br />27 <br />HSC 118295 - Containers shall be washed and decontaminated <br />information document and transportation records for 3 years. <br />pursuant to this section. <br />® <br />12. <br />HSC 117960 -LQG shall file MWMP with the EA. <br />El <br />28. <br />HSC 118305 - Reuseable drums or conainters used for medical <br />waste shall not be used for other storage. <br />❑ <br />13. <br />HSC 117975 - LQG shall maintain treatment and shipping and <br />❑ <br />29 <br />HSC 118307- Intermediate storage area shall be secured and <br />tracking documents for 2 years. <br />marked with proper signage. <br />Transportation <br />❑ <br />30. <br />HSC 118310 - Designated accumulation area shall be secured <br />and marked with proper signage. <br />❑ <br />14. <br />HSC 117946 - MOT exemption requirements for SQG. <br />Other <br />❑ <br />15. <br />HSC 117976 - MOT exemption requirements for LQG. <br />❑ <br />31. <br />❑ <br />16. <br />HSC 118032 - Pharmaceutical waste hauling exemption. <br />❑ <br />32. <br />Received by: Print: Karol <br />Specialist: Print: Benje <br />Sr REHS <br />r <br />n �1 <br />L Phone: 20 qs TS <br />tNYVk^, , Phone: (209) 468-3178 I <br />Reinspecion on/about: A reinspection fee of $130 per hour may be charged. Page 1 of 2 <br />EH -08/2015 <br />