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05/04/2011 15:39 FAX DAVITA BEN HOLT 12002/013 <br /> SAN JOAUIN COUNTY Date <br /> ° ENVIRONMENTAL HEALTH DEPARTMENT PR 0 <br /> w 600 East Main Street, Stockton, CA 95202 <br /> :. <br /> (209)468-3420 <br /> `P MEDICAL WASTE INSPECTION FORM <br /> FacilityName U\klk, FacitityAddress SUS W Q1rn_ o� bt. <br /> FacilityContact O"p-m\ �?a" c-r _Title�1�•_Fae;�:l �phone o X1'73., �j <br /> INSPECTION TYPE! KRoutine oComplaint ❑Re-inspection <br /> VIOLATION($) <br /> Registration THE ITEMS BELOW REPRESENT VIOLATIONS OF THE CALIFORNIA <br /> _1.HSC Section 117855-Large Quantity HEALTH & SAFETY CODE (HSC): <br /> Generator shall register with the enforcement <br /> agency ArlQrtg-ommencement ofs a generation of <br /> metliC41 waste. n, <br /> `2. HSC Section 117903-Permit from the 1 v® tiU ri(1 `�- ((� ' I1• <br /> enforcement agency required to treat medical <br /> waste. <br /> —3.HSC Section 117690-No large LOG shall <br /> generate medical waste unless registered with the -7 t �`�'Olds W-44-1 enforcement agency. 1 of Weq� G e. <br /> _4.HSC Section 117896-SQG that treats medL04�� �� <br /> waste shall register with enforcement agency. t <br /> _6.HSC Section 117900-Shall not haul med <br /> waste unless registered or obtained LQHE. <br /> ®6.HSC Section 117903-Shull not treat mad <br /> waste without permit from enforcement agency. <br /> _ An <br /> 7.HSC Section 117908-Common storage c t L <br /> facility shall be registered with local enforcementS Lr(V <br /> agency. <br /> Procedures <br /> _B.HSC Section 117936-SQG MWMP <br /> ,:9.HSC Section 117943-SQG Shall keep chv S <br /> records for 3 years. �.� <br /> 110.1-15C Section 117945-SQG not required to <br /> register shall keep records for 2 years. <br /> 11.HSC Section 117960-LOG shall file MMP <br /> with enforcement agency. <br /> `12.HSC Section 117875-LQG shall keep �`, � s <br /> records for 3 years. <br /> Transportation ri u,s (L' 14 jCCkL' <br /> —13,HSC Section 118030-LOI-IE application. <br /> Treatment/Storage � 1 <br /> _14.HSC Section 118135-Shall obtain a permit "t ® 1 <br /> from the enforcement agency to treat medical <br /> waste prior to tragling the waste. 0e(,f <br /> _15.HSC Section 11876S-All treatment records <br /> shall be kept for 3 years. <br /> 16.HSC Section 118215-All medical waste <br /> shall be treated pursuant to this section. <br /> _17.HSC Section 118220-Recognitaele human <br /> anatomical parts shall be disposed of by interment <br /> unless otherwise hazardous. ae <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 1182WMW label&contain <br /> i21.HSC Section 118286-Sh2rps label/contain <br /> _22.HSC Section 118295-Proper decon used. <br /> 23.HSC Section 118307-Interim storage labeled <br /> 24.HSC Section 118310-Enclosure labeled. <br /> _25.HSC Section 118305-Cannot reuse drums <br /> 26.119C Section 117630 Approved blohazard <br /> bag used, <br /> -.27.HSC Section 118276(g)•Pharm IabeUstore <br /> ,28.HSC Section 118222-inclnaration Required Insptz r Signature Receihd By ®ate' <br /> 29 Other-Describe in narrative. <br />