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eses D.Elam,MD <br /> KAISER PERIVIANEfEe 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 /> Department/ <br /> Print Name Sign Name Job Title* NUID Number Date <br /> Facility - <br /> Lo4 Leonora Romero EVS Aide A593414 EVS/,Manteca <br /> --- 1Eddie Stephnc?' � ENS S Aulc F:V ti/Nantcca <br /> F.deard Trapp_ _ _ FVS Aide 0574162 EVti/Vtan[eca <br /> EmmaZapata F.VSAide Q660116 EVS/Manteca <br /> 1_04 Vary Ochoa EVS Aid c I ' FVS1l rac, <br /> Niguel Rubaleaea llG .� �� EVS Aide_ ( 4/C233 LVSn7acp /ii/zcu <br /> Guillermo Mendoza _A�. �. EVS Aide_ 4 JD"SA�4� FVS/Iracy <br /> \ntanette Quinlml ,h. L� EVS.Aide _C°e'y) -ye EvsfTracy. ,�-//.}G1/ <br /> Y;7 Darin Rcongu,-. '�_ EVSAide (3N195Y;7 Evs/Tracy ;S-ll-ll <br /> I <br /> / -- -- ENS/Manteca <br /> Deanna Alvarez Ilet.Secrelar 1.723849 -e <br /> Course Instructor Name: V'I` L- (.yr <br /> Course Instructor Signature: C�)�Q,., <br /> Course Instructor Title. [_�/5 Sulxr�.Sur rage sol <br /> 'Joh descoplions are—dable far each Jab TAI,upon request <br /> Violation: HSC Section 18275 (g) —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 />