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®PQUV if <br /> SAN JOAQUIN COUNTY Date 9hilil <br /> 2: GyENVIRONMENTAL HEALTH DEPARTMENT PRD Ili] <br /> 600 East Main Street, Stockton, CA 95202 <br /> two <br /> (209)468-3420 <br /> MEDICAL WASTE INSPECTION FORM <br /> FacilityNameAD <br /> FacilityAddress 400S. presch Av" <br /> FacilityContact ti OOM my m@ l Title (botd. Phone# Z) wl 70W <br /> INSPECTION TYPE: %,Routine oComplaint iiRe-inspection <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 /> 'de--nerator shall register with the enforcement <br /> agency prior to commencement of the generation of <br /> medical waste. <br /> 2.HSC Section 117903-Permit from the <br /> enforcement agency required to treat medical ?�k!n(rcNIA!W.? fAn 10('Of <br /> waste. <br /> —3.HSC Section 117890-No large LQG shall i vq4e �nu Atj;�- (VEW ke, <br /> generate medical waste unless registered with the <br /> enforcement agency. �Ajgs4j 6\1AEr fsiw�rjdUGgjn IA016 <br /> —4.HSC Section 117895-SQG that treats med (A ZIA �Al <br /> waste shall register with enforcement agency. <br /> —5.HSC Section 117900-Shall not haul med <br /> waste unless registered or obtained LQHE' 'V e- <br /> 6.1-11SC Section 117903-Shall not treat med <br /> Lk -S� - FRCS k° Ck, <br /> waste without permit from enforcement agency. <br /> THSC Section 117908-Common Storage kk4mf'1 CNA P 4y-loyl 0 r\ L 0 14 6)1 %1 <br /> Ta-cility shall be registered with local enforcement <br /> M1�141A'%r�4 A A -VfCLL�LIM (kV <br /> agency. LUC-Lfh- 2)eAj Ej <br /> Procedures & <br /> —8.HSC Section 117935-SQG MWMP I h&5VC, \OWIM (aRfg-�j h-M <br /> —9.1-11SC Section 117943-SQG Shall keep <br /> records for 3 years. <br /> —10.HSC Section 117945-SQG not required to <br /> register shall keep records for 2 years. <br /> I 11.1-11SC Section 11 7960-LQG shall file MWMP X1 <br /> wit n enforcement agency. <br /> —12.HSC Section 117975-LQG shall keep <br /> records for 3 years. <br /> Transportation <br /> _XJ3.HSC Section 118030-LQHE application. <br /> Treatment/Storage i-\tA -)rS(AvW.r,. Jot <br /> —14.HSC Section 118135-Shall obtain a permit 4up It"I 'l, <br /> from the enforcement agency to treat medical <br /> waste prior to treating the waste. <br /> 115.1-11SC Section 118765-All treatment records <br /> shall be kept for 3 years. ki cs ix L4, 4-o , a(Ac aps)l, h� <br /> 16.HSC Section 118215-All medical waste DI 03 I <br /> f22 <br /> shall be treated pursuant to this section. - !1' &.%j 0� - <br /> —17.HSC Section 118220-Recognizable human QJ zk��jA\A�A& <br /> anatomical parts shall be disposed of by interment <br /> unless otherwise hazardous. <br /> 18.HSC Section 118225-Treated sharps shall <br /> bedestroyedor somehow prevent public access. <br /> 19.1-11SC Section 118275-MW red bags,path, <br /> chemo shall be labeled properly. <br /> —20.HSC Section 118280-MW label&contain <br /> 211.1-11SC Section 118285-Sharps label/contain <br /> —22.1-11SC Section 118296-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.HSC Section 117630-Approved biohazard <br /> bag used. <br /> —27.HSC Section 118275(g)-Pharm label/store <br /> —28.HSC Section 118222-Incineration Required Insp&&tor Signature N—fRecelfved By Date <br /> 29 Other-Describe in narrative. <br /> 4 <br /> (Q <br />