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aU(w SAN JQ <br /> OA UIN COUNTY Date I 3 <br /> P <br /> ENVIRONMENTAL HEALTH DEPARTMENT PR Oql b61b <br /> 1868 East Hazelton Ave., Stockton, CA 95205 <br /> (209)468-3420 <br /> cq<iFOR�'`P MEDICAL WASTE INSPECTION FORM <br /> FacilityName 0,%f+o,c.v, ((,jr. d Qk, Nkl. Un}cr FacilityAddress (AID r)OA A'r.e-. Akkn�eun <br /> FacilityContact W'11 V' cv% 11�,f1�w Title Aj �n,��aw�d� Phonel a <br /> INSPECTION TYPE: goutine ❑Complaint ❑ e-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. ' ' a�0 ,,,,, -T %40 (r4^n_ (� M14 M <br /> p <br /> _2.HSC Section 117903-Permit from the <br /> enforcement agency required to treat medical a vkA pilrA ) CSN f t <br /> waste. <br /> _3.NSC Section 117890-No large LQG shall d1 (A V� (AL1 — CV m e- 0. R <br /> generate medical waste unless registered with the W�(1Q �+ (A, (10elA111 <br /> S n11 <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 <br /> waste unless registered or obtained LQHE. (� <br /> _6.HSC Section 117903-Shall not treat med Nti QA j Lk & G'Vv- 5V-1) a @. <br /> waste without permit from enforcement agency. S r <br /> _7.HSC Section 117908-Common Storage D Uv S (�i T javU <br /> facility shall be registered with local enforcement <br /> agency. <br /> Procedures 4r M LVt-i n fa L ,fig <br /> _8.HSC Section 117935-SQG MWMP fgNAJAIS <br /> _9.HSC Section 117943-SQG Shall keep <br /> a <br /> records for 3 years. <br /> _10.HSC Section 117945-SQG not required to <br /> �JJester shall keep records for 2 years. <br /> vtl.HSC Section 117960-LQG shall file MWMP 1 <br /> with enforcement agency. ' 1VZA4C f2a� <br /> _12.HSC Section 117975-LQG shall keep <br /> records for 3 years. <br /> Transportation <br /> _13.NSC Section 118030-LQHE application. y o r <br /> Treatment/Storage <br /> From <br /> Section 118135-Shall obtain a permit i - >1 t'1 l JAS 'u <br /> from the enforcement agency to treat medical Ii1 <br /> waste prior to treating the waste. 1 L 1'1 ZAV W,f <br /> _15.HSC Section 118765-All treatment records <br /> shall be kept for 3 years. <br /> 16.HSC Section 11821 5-All medical waste <br /> sh_all be treated pursuant to this section. <br /> _17.HSC Section 118220-Recognizable human <br /> anatomical parts shall be disposed of by interment <br /> unless otherwise hazardous. <br /> _18.HSC Section 118225-Treated sharps shall <br /> be destroyed or somehow prevent public access. <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 <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 Aw <br /> 28.HSC Section 118222-Incineration Required InspUctor Signature Received By Da e <br /> 29 Other-Describe in narrative. <br />