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oPq`'tN SAN JOAQUIN COUNTY Date <br /> E 1RONMENTAL HEALTH DEPARTME PR <br /> N { 600 East Main Street, Stockton, CA 95202 <br /> (209)468-3420 <br /> MEDICAL WASTE INSPECTION FORM <br /> FacilityName Nr�cru. A' ;w.\ N ilityAddress!! 400 S. if,-,,,oAvt_ <br /> FacilityContact 7on�t M go CelTitleTp6rtw4 (PvA• Phone#a01) q 01U <br /> INSPECTION TYPE: ARoutine []Complaint ❑Re-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 /> Generator shall register with the enforcement <br /> agency prior to commencement of the generation of <br /> medical waste. t._2.HSC Section 117903-Permit from the <br /> enforcement agency required to treat medical 'L, 11 C <br /> e <br /> waste. r , <br /> _3.HSC Section 117890-No large LQG shall <br /> generate medical waste unless registered with the <br /> enforcement agency. <br /> _4.HSC Section 117895-SQG that treats med <br /> waste shall register with enforcement agency. <br /> _5.HSC Section 117900-Shall not haul med N C ' tt 1 b. V i <br /> waste unless registered or obtained LQHE. , <br /> _6.HSC Section 117903-Shall not treat med <br /> waste without permit from enforcement agency. L -A 1 '`,��'` 1 <br /> _7.HSC Section 117908-Common Storage L- `L, 1Lv\ ®jWh • f+' �"" -ALL t u t4�--!t) <br /> facility shall be registered with local enforcement 11 <br /> Ie-i ( 9 J a 11 1 S <br /> agency. Im <br /> J i0N <br /> Procedures a 1-J, sIg <br /> _8.HSC Section 117935-SQG MWMP ► ; i SS �U�S f <br /> _9.HSC Section 117943-SQG Shall keep <br /> records for 3 years. ®�Q, <br /> _10.HSC Section 117945-SQG not required to <br /> register shall keep records for 2 years. <br /> 11.HSCSection 117960-LQG shall file MWMP <br /> with enforcement agency. f1A (^� <br /> _12.HSC Section 117975-LQG shall keep <br /> records for 3 years. A1 44;1 ' <br /> Transportation LtSLIZ On 1, " (A t 11ns �,S2= <br /> _13.HSC Section 118030-LQHE application. (- ' tk K!` ) O� [� <br /> Treatment/Storage <br /> _14.HSC Section 118135-Shall obtain a permitLLrj <br /> @ <br /> from the enforcement agency to treat medical ifj <br /> waste prior to treating the waste. I 6t"At+cvA Pie <br /> _15.HSC Section 118765-All treatment records <br /> shall be kept for 3 years. '1" ,V,3 AYJ W Q'' <br /> _16.HSC Section 118215-All medical waste ® ' j1 <br /> shall be treated pursuant to this section. ILAiii . UT-V y T 111-10P.�.11 R- <br /> _17.HSC Section 118220-Recognizable human <br /> anatomical parts shall be disposed of by interment S <br /> unless otherwise hazardous. �l l L <br /> _18.HSC Section 118225-Treated sharps shall U <br /> be destroyed or somehow prevent public access. 41Zu— <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 �y �`kb� �U g _ <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.HSC Section 117630-Approved biohazard <br /> bag used. <br /> _27.HSC Section 118275(g)-Pharm label/store "-A.,�A,' Ah" <br /> �28.HSC Section 118222-Incineration Required Inspe for Signature eCe e y Date <br /> 29 Other-Describe in narrative. <br />