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""I" sod MEDICAL WASTE&PECTION REPORT Date: I 9 <br /> Q e San Joaquin County Environmental Health Department Program _ <br /> w; <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: <br /> (209)468-3420 Program <br /> www.sjogv.org/ehd Element: <br /> Facility Name Address City Zip Code <br /> DaVita Port City Dialysis 1810 s.fresno ave. Stockton 95206 <br /> Facility Contact Title Phone Number Email Inspection Type <br /> Narey Khun Facility Administrator 209-946-0738 narey.khun@davi Routine <br /> ta.com <br /> The above facility is inspected for compliance with Division 104,Part 14 of California Health and Safety Code(HSC). <br /> Registration Treatment <br /> HSC 117890-No LQG shall generate medical waste unlessHSC 118130-All onsite medical waste treatment facilities shall <br /> ❑ 1' registered with the EA. El17' be permitted by the EA. <br /> ❑ <br /> HSC 117950-LQG shall register with the EA prior to 2' generating medical waste. ❑ 18. HSC 118165-All treatment records shall be kept for 3 years. <br /> [j 3 HSC 117903-Permit from the EA is required prior to treating ❑ 19 HSC 118215-All medical waste shall be treated pursuant to <br /> medical waste. this section. <br /> HSC 117925-SQG that treats medical waste onsite shall HSC 118220-Pathology waste of a human nature shall be <br /> ❑ 4' register with the EA. ❑ 20. disposed of by interment,incineration,or an approved <br /> alternative. <br /> HSC 117900-Shall not haul medical waste unless registered, HSC 118222-Contaminated pathology waste,trace chemo <br /> El5. common carrier,trauma scene practitioner,or exempted ❑ 21. waste,or pharm waste from health care settings shall be treated <br /> under the MOT exemption. by incineration or an approved alternative. <br /> HSC 117928-Common Storage Facility shall have permit HSC 118225-Sharps waste shall be treated pursuant to this <br /> ❑ 6' issured by the EA. E] 22. section. <br /> ❑ 7 HSC 117890-LQG shall notify EA 72 hours prior to Containment/Storage <br /> participating in temporary event. <br /> HSC 117895-SQG shall notify EA 72 hours prior to HSC 117630-Biohazard bag shall meet the standards set forth <br /> El 8' <br /> participating in temporary event. ❑ 23. in this section. <br /> HSC 118275-Medical,biohazardous,sharps,trace chemo, <br /> Records/Documentation ® 24 pathology,or pharmaceutical waste shall be segregated and <br /> contained pursuant to this section. The container shall be <br /> properly labeled. <br /> ❑ 9. HSC 117935-Registered SQG shall file MWMP with the EA. ❑ 25 HSC 118280- Biohazard bags shall be containerized and <br /> stored pursuant to this section. <br /> HSC 117943-SQG required to register shall maintain HSC 118285-Sharps waste shall be containerized and stored <br /> ❑ 10. 26 <br /> treatment and shipping and tracking records for 3 years. ❑ . pursuant to this section. <br /> HSC 117945-SQG not required to register shall maintain HSC 118295-Containers shall be washed and decontaminated <br /> ❑ 1 information document and transportation records for 3 years. El 27. pursuant to this section. <br /> ❑ 12. HSC 117960-LQG shall file MWMP with the EA. ❑ 28. HSC 118305- Reuseable drums or conainters used for medical <br /> waste shall not be used for other storage. <br /> HSC 117975-LQG shall maintain treatment and shipping and HSC 118307- Intermediate storage area shall be secured and <br /> El 13. 29 <br /> tracking documents for 2 years. ❑ ' marked with proper signage. <br /> Transportation ❑ 30. HSC 118310-Designated accumulation area shall be secured <br /> and marked with proper signage. <br /> ❑ 14. HSC 117946-MOT exemption requirements for SQG. Other <br /> ❑ 15. HSC 117976-MOT exemption requirements for LQG. ❑ 31. <br /> ❑ 16. HSC 118032-Pharmaceutical waste hauling exemption. ❑ 32. <br /> Nu 1 <br /> Received by: Print: Nit P Signature: Phone: e? (Ir - 1 <br /> Specialist: Print: J.Easter Signature: Phone: 209-953-7310 <br /> Reinspecion on/about: A reinspection fee of$152 per hour may be charged. _ Page 1 of 2 <br /> EH-11/17 <br />