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• <br />KAISER PERMANENTEo <br />LOA <br />/_0 <br />i <br />Moses D. Elam, MD <br />Physician -in -Chief <br />Corwin N. Harper, MHA, FACHE <br />Senior Vice President/Area Manager <br />Central Valley Service Area <br />PHARMECEUTICAL WASTE SEGREGATION <br />Date/Time: APRIL- MAY 2011 <br />Location: Manteca/Tracy Medical Center <br />Print Name <br />Sign Name <br />- <br />Job Title' <br />- <br />NUID Number <br />De partmen <br />Facility__ <br />Date <br />Leonora Itomrro <br />- <br />EVS Aide <br />A593414 <br />EVS/3lanteca <br />�—^ <br />I d tic Steldincy_ <br />- <br />F VS AideI <br />I slminteca <br />1•.dastrd TraP'L.. _ <br />__ <br />(✓ <br />FNS Aide <br />— - . _—. <br />I 074162 <br />__— - <br />_ , G I <br />f \S/Manlcca <br />14nuua 7a t�ll•.t-__ <br />r <br />/j7 � <br />usAide <br />Q(61111( <br />f 4S/\lantcca S. y /� <br />EVS Aide <br />EVS AIdC <br />_Nary 0chuoa <br />AMICI ltnh Il a— <br />t _/ <br />(- `r/C'233 <br />1 A Srf'r— <br />l A sf rract• •Jr�//��C// <br />- 1.4"6�T^ <br />1•NS Aide <br />Guillermo Wndoza _ <br />_._ _�_ <br />_ Oo jS'S 344- <br />TVS/rracc <br />Antm-0te hlinlua <br />1-� <br />P.VS <br />i3 �= <br />EVS/Tr.OL)c)_ <br />Darin 13ennclt <br />P}"'"' <br />EVS Aide <br />Deanna Alrarci <br />- <br />Dc 1. SurcLlry <br />_ <br />1,723849 <br />FVS/Nanlcca <br />Trac <br />Course Instructor Name <br />Course Instructor Signature: QQ OL— <br />Course Instructor Title: r --V`-' S_p+-Cd, Sar <br />'Job deso plions are available for each Job Tile upon request <br />Violation: HSC Section 18275 (it) — Pharm label/store — There are pharm sharps containers that <br />lack label "Incineration Only" on the sides. These containers are located located in the <br />Pharmacy, the CDA, SNF, the Soiled Utility Room in the Med Surg Unit, the Utility Room in <br />the ED, and the Oxygen Storage Room. <br />Corrective Statement: Take a photo of all sides and top of one correctly labeled <br />pharmaceutical container and submit by 5/20/11. <br />Page 4 of 5 <br />Stockton Medical Office Manteca Medical Center Tracy Medical Offices Modesto Medical Offices <br />7373 West Lane, Stockton, CA 95210 1777 W. Yosemite Avenue, Manteca, CA 95337 2185 W. Grant Line Road, Tracy, CA 95377 Post Office Box 577680, Modesto, CA 95357 <br />