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PaU!� SAN JOAQUIN COUNTY Date 101-1 (10 <br /> E#VIRONMENTAL HEALTH DEPARTIMIEff PR ONS OW1 <br /> 600 East Main Street, Stockton, CA 95202 <br /> (209)468-3420 <br /> ® �`P MEDICAL WASTE INSPECTION FORM <br /> FacifityName <br /> \-C, cA FacifityAddress Ave,_ <br /> Fcili ontac 0`2�2® �,� iamSTitle e#a�pnqu-%Dls <br /> INSPECTION ® AlRoutine oComplaint ❑ -i ci <br /> VIOLATION(S) <br /> Registration THE ITEMS BELOW REPRESENT VIOLATIONS OF THE CALIFORNIA <br /> _1.HSC Section 117955-Large Quantity HEALTH & SAFETY CODE (HSC): <br /> Generator shall register with the enforcement <br /> agency prior to commencement of the generation of <br /> medical waste. 9 . °�! (Ali 0 l W k <br /> _2.HSC Section 117903-Permit from the <br /> enforcement agency required to treat medical Q f(1QUL <br /> M P I4%kiA'16 <br /> waste. <br /> _3.HSC Section 117890-No large LOG shall { f 1-415)1 �� a.n rl-rc"1G <br /> generate medical waste unless registered with the0L4`4n j e <br /> enforcement agency. <br /> _4.HSC Section 117895-SQG that treats med " 1 . <br /> waste shall register with enforcement agency. <br /> _5.HSC Section 117900-Shall not haul med <br /> waste unless registered or obtained LQHE. 1 <br /> _6.HSC Section 117903-Shall not treat med (k 'k'I�AkSeSsksti Lm LL t <br /> waste without permit from enforcement agency. `` , t �� <br /> 7.HSC Section 117908-Common Storage �'wlL� L <br /> fa_cility 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 /> _10.HSC Section 117945-SQG not required to ,- I <br /> register shall keep records for 2 years. (1& ;O Yl S <br /> -Y,11.HSC Section 117960-LQG shall file MWMP " <br /> � j. <br /> with enforcement agency. T ; �9a LL tCl Wim'` <br /> _12.HSC Section 117975-LQG shall keep 1KS O ) <br /> records for 3 years. <br /> Transportation ali& <br /> _13.HSC Section 118030-LQHE application. ®a 1�lo V ti �o U O <br /> Treatment/ torn e c <br /> _14.HSC Section 118135-Shall obtain a permit tJWS iU t c- a5111 iQT [at OL UV�S <Yl <br /> from the enforcement agency to treat medical a <br /> waste prior to treating the waste. <br /> _15.HSC Section 11 8765-All treatment records LL <br /> shall be kept for 3 years. >, 1 vlJeJ Lb z1 n T' <br /> _16.HSC Section 118215-All medical waste <br /> shall be treated pursuant to this section. <br /> _17.HSC Section 118220-Recognizable human S U <br /> anatomical parts shall be disposed of by interment i r <br /> unless otherwise hazardous. <br /> _18.HSC Section 118225-Treated sharps shall �mQ' <br /> y I' <br /> be destroyed or somehow prevent public access. 1C2 ,IMO � c" <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 118307-Interim storage labeled <br /> 24.14SC Section 118310-Enclosure labeled. <br /> _25.HSC Section 118305-Cannot reuse drums <br /> _26.HSC Section 117630-Approved biohazard /® /�l` <br /> bag used. <br /> —27.HSC Section 118275(8)-Pharm label/store <br /> 28.HSC Section 118222-Incineration Required InspWaor Signature Recelved By Date <br /> 29 Other-Describe in narrative. <br /> P��E 2 <br />