Roll Call Public Comment WASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING Board Room
- Health Department Building Wells Avenue at Ninth Street August 25, 2011

ApprovaJlAdditions/Deletions
- Agenda
- August 25,2011 2 Review
- Approval of Minutes
- Minutes ofJuly28,2011 2-3 Recognitions 3

Proclamation
- "ObesityAwareness Day" 3 Proclamation
- "Clean Hands Montli' 3-4 ConsentAgenda
- Empire Distributing
- Case No. 1064, NOV No. 4612 4-5 ConsentAgenda
- BudgetAmendments/lnterlocal Agreements

Retroactive Approval of District Health Officer's Acceptance ofAssistance 5 Amendment

### #1 from the US Environmental Protection Agency (EPA) to Increase Funding -AirQuality Management, EPAAir Pollution Control Program, 10 10019

Approval- Notice ofSubgrant Ward from the Nevada State Health Division in 5 Support
- Assistant Secretaryfor Preparedness and Response (ASPR) Hospital Preparedness Program; and Approval ofAmendments Totaling an Increase
- FY 12ASPR Hospital Preparedness Federal Grant Program, 10 10708

Approval- Notice ofSubgrantAward
- Nevada State Health Division
- Women, 5 Infants, and Children (WIC) Clinic Program
- Support ofSalaries and Benefits; Travel and Training; and Operating Expenditures Regional Emergency Medical Services Authority A. Review and Acceptance ofthe Operations and Financial Report
- June and 6-7 July2011 B. Update
- REMSA's CommunityActivities Since June 2011 7 Presentation and Possible Approval ofthe Washoe County District Health 7- 11 Department's Franchise Compliance Report forthe Regional Emergency Medical Services Authority (REMSA) forJuly 1,2009 Through June 30, 2010 Acceptance of District Health Department Monthly Public Health Fund Revenue 

### 11 and Expenditures forJuly2011 Fiscal Year 12 Update 11 - 12WASHOE COUNTY DISTRICTBOARD OF HEALTH MEETING August 25, 2011 Page 2

Public Hearing
- Washoe County District Board of Health Regulations Governing Public Bathing Places and Public Spas 

### A. Presentation and Discussion of Proposed Additions ofSection 010 (Definitions); Section 020 (Public Swimming Pool and Spa Operator Requirements); and Section 030 (EnforcementActions) B. Recommendation to Approve and AdoptAdditions to the Washoe County District Board of Health Regulations Governing Public Bathing Places and Public Spas Public Hearing
-Washoe County District Board of Health Regulations Governing Solid Waste Management A. Presentation and Discussion of Proposed Deletion ofSection 090.000- 090.195, Inclusive (Land Disposal Facility); B. Presentation and Discussion of Proposed Additions to Section 010 (Definitions), Specifically Section 010.010 (Active Portion); Section 010.022 (AnnularSpace); Section 010.086 (Bird Hazard); Section 010.146 (Composite Liner); Section 010.278 (Face Amount); Section 010.438 (Lower Explosive Limit); Section 010.538 (Period for Repayment into Fund); Section 010.618 (Salvage Yard); Section 010.734 (Type IError); Section 010.754 (Washout); Section 010.762 (Waste Management Unit Boundary); and Section 090.001 - 090.557, Inclusive (Landfill/Municipal Solid Waste Landfill Unit); C. Presentation and Discussion of Proposed Amendments to Section 010 (Definitions), Specifically Section 010.408 (Lateral Expansion); and Section 010.428 (Liquid Wastes); D. Recommendation to Approve and Adopt the Additions, theAmendment and Deletions to the Washoe County District Board of Health Regulations Governing Solid Waste Management Public Hearing Washoe County District Board of Health RegUlations Governing Solid Waste Management Public Hearing
- State Implementation Plan (SIP) 

### A. Presentation and Possible Discussion ofthe Revision to the Washoe County Portion ofthe Nevada State Implementation Plan (SIP), Which Demonstrates the Washoe County Health District's Compliance with the Lead Infrastructure SIP Requirements ofthe CleanAirActSection 110(a)(2) 12-18

18 -20

20


### 20

- 21WASHOE COUNTY DISTRICTBOARD OF HEALTH MEETING August 25,2011 Pagel

B. Recommendation to Approve and Adopt the Revision to the Washoe County Portion of the Nevada State Implementation Plan (SIP), Which Demonstrates the Washoe County Health District's Compliance with the Lead Infrastructure SIP Requirements ofthe CleanAirActSection 110(a)(2) Staff Reports Division Director
- Epidemiology and Public Health Preparedness Division Director
- Community and Clinical Health Services Division Director
- Environmental Health Services Division Director
- AirQuality Management Division Director
- Administrative Health Services Officer District Health Officer Board Comment Public Comment Adjournment 21 - 22

22 23 -25 25 -26 26 -28

28 28-29 29 29 

### 30WASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING AUGUST 25, 2011

PRESENT: Mr. Matt Smith, Chairman; George Furman, MD; Councilman Dan Gustin; George Hess, MD; Denis Humphreys, 

### 00; and Councilwoman Julia Ratti ABSENT: Commissioner Kitty Jung, Vice Chairman STAFF: Dr, Joe Iser, District Health Officer; Eileen Coulombe, Administrative Health Services Officer; Bob Sack, Director, Environmental Health Services Officer; Dr. Randall Todd, Director, Epidemiology and Public Health Preparedness; Mary-Ann Brown, Director, Community and Clinical Health Services; Kevin Dick, Director, Air Quality Management; Patsy Buxton, Fiscal Compliance Officer; StaceyAkurosawa, EMS Coordinator; Jeanne Rucker, Environmental Health Specialist Supervisor; Bryan Tyre, PE, SeniorEnvironmental Engineer; Jim English, SeniorEnvironmental Health Specialist; Noel Bonderson, AirQualitySpecialist Supervisor; Dan Inouye, AirQuality Specialist; MaryAmes, OfficeAssistant II; Bev Bayan, WIC Program Manager; Bryan Wagner, SeniorEnvironmental Health Specialist; Mark Dougan, Environmental Health Specialist; Kim Franchi, Environmental Health Specialist; Krista Hunt, Environmental Health Specialist; Wes Rubio, Environmental Health Specialist; Steve Fisher, Department ComputerApplication Specialist; Amber English, Environmental Health Specialist; Phil Ulibarri, Public Information Officer; Kelli Seals, Public Health Nurse; Peg Caldwell, RN; Peggy Quinlan, Environmental Health Specialist; Lee Salgado, Environmental Health Specialist; Janet Smith, Recording Secretary; and Leslie Admirand, Deputy DistrictAttorney

At 1 :05pm, Chairman Smith called the Washoe County District Board of Health meeting to order, followed by the Pledge ofAllegiance, led by Councilman Dan Gustin, memberofthe Washoe County District Board of Health,

ROLL CALL Roll call was taken and aquorum ofthe Board noted, Mrs, Janet Smith, CPS, Recording Secretary, advised that CommissionerKittyJung, Vice Chair, was excused,

PUBLIC COMMENT There was no public comment presented,WASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING August25, 2011 Page 2

APPROVAL/DELETIONS
- AGENDA
- AUGUST 25,2011 Chairman Smith stated item 

### 7.CA. ConsentAgenda
- Ratification of Interlocal Contract with the State of Nevada, Department of MotorVehicles, forthe DMV Excess Reserve Grant Program, 10 TBD has been withdrawn.
Chairman Smith advised, Item 15. Public Hearing
-- Washoe County District Board of Health Regulations Governing Solid Waste Management, specific to the definition ofgarbage has been withdrawn and will be rescheduled forthe Board's October27,2011 meeting.
Chairman Smith called upon anyone wishing to make astatement regarding the Public Hearing for the Solid Waste Management Regulations, specific to the definition ofgarbage. There was no one present wishing to make apublic comment.
Ms. Ratti Stated, the Sparks City Council will have Council workshop sessions to "discuss and educate the Council members on specific issues; that she would question ifthe Board should consider scheduling such asession to discuss the complexities ofthis issue. Or ifthe Board members should attend aworkshop session." Stated, "as there isn't an interestto have aBoard workshop session, she would request notification regarding the public workshop sessions." MOTION: Dr. Humphreys moved, seconded by Mr. Gustin, that the agenda ofthe District Board of Health August 25, 2011, meeting be approved as amended. Motion carried unanimously.

APPROVAL/ADDITONS/CORRECTIONS
- MINUTES
- JULY28,2011 Chairman Smith called for any additions orcorrections to the minutes ofthe July 28, 2011 meeting ofthe Washoe County District Board of Health.
Dr. Humphreys Stated, the date on the Table ofContents should be corrected toJuly28,2011. MOTION: Mr. Gustin moved, seconded by Dr. Humphreys, that the minutes ofthe District Board of Health July 28, 2011 meeting be approved as received,WASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING August 25, 2011 Page 3

with the noted correction to the Table of Contents. Motion carried unanimously.

RECOGNITIONS AND PROCLAMATIONS Chairman Smith and Dr. Joseph Iser, District Health Officer, recognized Ms. MaryAmes for earning her International Association ofAdministrative Professionals (lAAP)
- Certified Professional Secretary (CPS) level ofcertification.

PROCLAMATION -SEPTEMBER 8, 2011-"OBESITYAWARENESS DAY' Dr. Iser read the Proclamation declaring September8,2011, as "ObesityAwareness Day" (a copy ofwhich was placed on file forthe record). Chairman Smith and Dr. Iserpresented the Proclamation to Ms. Kelli Seals, Community Health Nurse. MOTION: Mr. Gustin moved, seconded by Dr. Furman, thatthe Proclamation declaring SeptemberS, 2011 as "ObesityAwareness Day" be approved and adopted as presented. Motion carried unanimously.

PROCLAMATION
- SEPTEMBER 2011 - "CLEANHANDS MONTH" Dr. Iser read the Proclamation declaring the month ofSeptember2011, as "Clean Hands Month"(a copy ofwhich was placed on file for the record). Chairman Smith and Dr. Iserpresented the Proclamation to Mr. Bryan Wagner, Senior Environmental Health Specialist; Mr. Mark Dougan, Environmental Health Specialist; and Ms. Kim Franchi, Environmental Health Specialist.
Mr. Bryan Wagner, Senior Environmental Health Specialist Stated, the Proclamation is through the efforts ofthe Nevada Food SafetyTask Force to "further increase the safety offood." Advising, the Centers for Disease Control and Prevention (CDC) has been determined "hand washing is the 'first line ofdefense' in preventing illness and the single most important means ofpreventing the spread of infection."WASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING August 25, 2011 Page 4

Advised this year's efforts are focused on teaching children properhand washing, as children "learn by example; and develop new habits through repetition, accompanied with positive reinforcement." Advised both influenza and norovirus are frequently transmitted by individuals who fail to properlywash their hands; that Stafffrequently investigate outbreaks at childcare centers directly related to poor hand washing techniques. Advised some Washoe County School Districts experience a::10% rate ofabsenteeism due to influenza outbreaks.
Ms. Kim Franchi. Environmental Health Specialist Presented agraph depicting the numberofoutbreaks of confirmed and suspected cases of norovirus and influenza investigated bythe District Health Department Epi Team, from 2007 through 2011 (to-date), advising, these represent "reported cases only, as the vast majority of cases go unreported." Advised from 2007 through 2009, Staffnoted an increase in the numberof cases; thatthere was amarked decrease in 2010, which Staffattributes to the Health District's public outreach educational efforts. Stated, as Mr. Wagner indicated, the Health District "has targeted children in these efforts, as children are notoriously known for being poorhand-washers; that teaching children howto properlywash hands develops and fosters alife-long learning habit." Ms. Franchi reviewed Staff's previous efforts in educating children in proper hand washing techniques. Advised October 15th is Global Hand Washing Day; that globally, diarrheal diseases and acute respiratory infections case 3.5 million deaths ofchildren underthe age offive (5) every year. Stated the goal of "Clean HandsMonth"is to decrease the spread of infectious diseases; that "the simple act of hand washing with soap and water is the key." MOTION: Dr. Humphreys moved, seconded by Dr. Hess, that the Proclamation declaring September2011 as "Clean Hands Month", be approved and adopted as presented. Motion carried unanimously.

CONSENTAGENDA
- AIR QUALITY MANAGEMENT CASE
- EMPIRE DISTRIBUTING
- CASE NO. 1064, NOV NO. 4612 Staff advised that Citation No. 4612, Case No. 1064 was issued to EMPIRE DISTRIBUTING, on June 16, 2011, forfailure to file the required properchange ofownership paperwork with theAir Quality Management Division, in violation ofSection 030.2175 (Operations Contraryto Permit) of the Washoe County District Board of Health Regulations Governing Air Quality Management. Staff advised Empire Distributing was advised ofthe right to appeal; however, no appeal was filed. Staff recommends Citation No. 4612, Case No.1064 (Empire Distribution) be upheld and afine in the amount of $200 be levied as anegotiated settlementforamajorviolation.WASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING August 25. 2011 Page 5

In response to Mr. Gustin Regarding the violation, Mr. Noel Bonderson, Air Quality Supervisor, stated there was achange in the ownership of Empire Distributing. Advised, afterseveral attempts by Staffto have the new owners submit the required paperworkfor that change ofownership with no response, Staff issued aNotice ofViolation. MOTION: Mr. Gustin moved, seconded by Ms. Ratti, that Citation No. 

### 4612, Case No. 

### 1064 (Empire Distributing), be upheld and afine in the amount of 

### $200 be levied as anegotiated settlement foramajorviolation. Motion carried unanimously.

CONSENTAGENDA
- BUDGETAMENDMENTSIINTERLOCALAGREEMENTS The Board was advised Staff recommends retroactive approval ofthe District Health Officer's acceptance ofAssistance Amendment#1 from the US Environmental Health Protection Agency (EPA) to increasefunding by 

### $258,225 for the total funding amount of

### $699,331 forthe Air Quality Management, EPAAir Pollution Control Program, 

### 10 10019, for the period of October 1, 2010 through September30, 2011.
The Board was advised Staff recommends approval ofthe Notice of Subgrant Award from the Nevada State Health Division in the amountof

### $404,044 (with 

### $40,404 or 

### 10% match) in support ofthe Assistant Secretaryfor Preparedness and Response (ASPR) Hospital Preparedness Program, forthe period ofJuly 1, 2011 to June 30, 2012; and approval of amendments totaling an increase of

### $35,814 in both revenue and expense to the FY 

### 12ASPR Hospital Preparedness Federal grant Program, 

### 1010708.
The Board was advised Staff recommends approval of Notice ofSubgrant Award from the Nevada State Health Division forthe Women, Infants and Children (WIC) Clinic Program in the total amount of

### $1,071,998 in support ofSalaries and Benefits, Travel and Training, and Operating Expenditures. forthe period ofOctober 1, 2011 through September30, 2012. MOTION: Ms. Ratti moved, seconded by Mr. Gustin, that the retroactive approval ofthe Health Officer's acceptance Assistance Amendment#1; and the Notices ofSubgrantAwards, with the corresponding budget amendment, be approved as presented, and the Chairman authorized to execute on behalfofthe Board where applicable. Motion carried unanimously.WASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING August 25, 2011 Page 6

REGIONAL EMERGENCY MEDICAL SERVICES AUTHORITY A. Review and Acceptance ofthe Operations and Financial Report
- June and July 2011 Mr. Jim Gubbels, Vice President REMSA Advised the Board members have been provided with acopyofthe June 2011 Operations and Financial Report; that the overall emergency response times for life-threatening calls in June 2011 was 91%and 94% for non-life threatening calls; that within the eight (8) minute zone it was 91%; within the fifteen (15) minute zone it was 100%; and within the twenty (20) minute zone itwas 97%. The overall average bill for airambulanceforJune was $6,783, with ayear-to-date average of $7,026. The overall average bill forground ambulance service forJune was $905, with ayear-todate average of$968.
Advised the Board members have been provided with acopy ofthe July2011 Operations and Financial Report; that the overall average emergency response time for life-threatening calls in July was 91% and 95% for non-life threatening calls; that within the eight (8) minute zone it was 91%; within the fifteen (15) minute zone it was 95%; and within the twenty (20) minute zone it was 97%. The overall average bill for air ambulance forJulywas $7,711, which is the year-to-date average. The overall average bill forground ambulance service forJuly was $988, which is the year-to-date average.
In response to Dr. Humphreys Regarding the allowable average bill for airand ground ambulance, Mr. Gubbels advised at the end ofthe Fiscal Year, REMSA is allowed the Consumer Price Index (CPI), which changes the average allowable rate REMSA can charge. Stated, if REMSA exceeds the allowable average bill from the previous year, REMSA "then subtracts the difference for the new allowable average." Advised the allowable average for Care Flight was $6,939; however, at the end of the Fiscal Year the average bill for air ambulance services was $7,026; therefore, the $87 difference is subtracted from the allowed CPI increase to determine the allowable monthly average of$7,089 forthe new Fiscal Year.
Advised the allowable average forground ambulance service was $966; however, at the end ofthe Fiscal Yearthe average bill forground ambulance service was $968; therefore the $2 difference is subtracted from the allowed CPI increase to determine the allowable monthly average of$1,002 for the new Fiscal Year.WASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING August 25, 2011 Page 7

In response to Chairman Smith Regarding negative customercomments, Mr. Gubbels advised that last month the Board members were provided with "a pie chart ofthe comments received for the quarter, depicting the percentage ofpositive and the negative comments; the percentage of neutral and non-responses; and clinical comments. Stated the monthly comments are listed in each monthly report; that itwas the consensus ofthe Board the pie chart would be submitted on aquarterly basis. Advised, "piecharting the comments received was the recommendation ofthe ambulance accreditation service that reviewed REMSA in February."
Advised for the last Fiscal Year less than .2% ofall the comments received were "clinical concerns; that the return rate forthe comment cards is 6.55%, which is agood return rate." MOTION: Ms. Ratti moved, seconded by Dr. Hess, that the Operations and Financial Reportforthe months ofJune and July2011 be accepted as presented. Motion carried unanimously.
B. Update of REMSA's Community Activities Since June 2011 Mr. Gubbels Advised, next month, Ms. Melissa Krall, Directorfor Community Outreach, will present the Cribs for Kids Program to the Board.

PRESENTATION
- WASHOE COUNTY DISTRICT HEALTH DEPARTMENT'S FRANCHISE COMPLIANCE REPORT
- REGIONAL EMERGENCY MEDICAL SERVICES AUTHORITY (REMSA)
- JULY 1,2009 THROUGH JUNE 30 2010 Ms. Eileen Coulombe, Administrative Health Services Officer Advised the Board members have been provided with acopy ofthe Washoe County District Health Department's Franchise Compliance Reportforthe Regional Emergency Medical Services Authority (REMSA) for the period ofJuly 1, 2009 through June 30,2010 (a copy ofwhich was placed on file forthe record.)WASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING August 25,2011 Page 8

Stated she would commend Ms. StaceyAkurosawa, EMS Coordinator; and Ms. Peg Caldwell, RN in the EMS Program, for "theirsignificant input in reviewing the data and preparing the Compliance Report.
Advised Staff recommends the District Board of Health determine REMSA to be in compliance with thirty (30) ofthe thirty-one (31) performance requirements for Fiscal Year2009/2010; and in sUbstantial compliance with Section 

### 2. Board Meetings, ofthe performance requirements.
In response to Dr. Humphreys Regarding Section 23., which was repealed, Ms. Coulombe advised Section 23., was repealed in August 2003; therefore, it would not be reviewed forcompliance.
Ms. Ratti Stated, she would commended Staff "forthe level ofdetail in this year's Compliance Report; that Staff's efforts are apparent." Stated, as she previously advised, "from asystems approach she is concerned as to the District Board of Health's abilityto fulfill its oversight role regarding the Franchise. The Compliance Report is for FY 09/10, and this is August2011." Stated, she acknowledges the EMS Coordinator position was vacant foran extended period oftime; thatthere is anew Health Officerand there have been anumberofother issues; however, "it is incumbent upon Staffto ensure the Reports" are submitted.
In response to Ms. Ratti Regarding when the FY 10/11 Compliance Report will be submitted, Ms. Coulombe advised "the Compliance Report is based on the Fiscal Year; that there "is the close-out of the Fiscal Year and the completion ofthe external audit." Advised, all ofthe documentation is provided to the Health Officer and Administrative Health Services Officerfor review and utilized in determining compliance with the Franchise Agreement. Advised, "the responsibility forcompliance is (usually) ninety (90) days afterthe close-out and completion ofthe external audit; therefore, the Compliance Reportfor FY 10/11 would be March 2012."
Ms. Ratti Stated, "there will always be vacancies within the Department within theforeseeable future; that it is necessaryto determine howto complete annual compliance reports." Stated, the ComplianceWASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING August 25,2011 Page 

### 9

Report for the ambulance franchise is the "most meaningful oversight process forthe Franchise Agreement."
In response to Ms. Ratti Ms. Coulombe acknowledged "thatthis [Compliance Report] is apriority;" that the Compliance Reportfor FY 10/11 will be submitted on time.
Ms. Ratti Stated, she "feels there should be improvements to several Sections ofthe Franchise Agreement, as she has concerns regarding Section 5. Periodic Competitive Bid Requirement; and obtaining sufficient information to ensure the prices are being kept as low as possible forthe citizens ofthe community served bythe FranchiseAgreement."
Stated she has concerns regarding Section 9. Response Requirementof Eight (8) Minutes 90% of the Time, "as to the level ofdata to which the Board has access; and being able to make decisions to help the otherjurisdictions in making decisions on the otherfacets ofthe emergency medical systems." Stated, she has concerns regarding Section 28. REMSA's Exclusive Right to Operate; that "the Agreement renews automatically 'unless there is material and adverse failure', which does not allow forthe opportunityto make some ofthe amendments to the FranchiseAgreement she believes need to be made, unless it is mutually agreed upon." Stated, she would question "howto getto the pointof mutually agreed upon improvements to the Franchise Agreement?" Stated, she has concerns regarding Section 29. Any Future Service Agreements with Other Political Entities. Stated, the Board has been advised REMSA is "doing no otherwork that would impinge upon the service levels provided to Washoe County; however, as aBoard membershe does notfeel as though she has the information necessary to explain that to herconstituents." Stated, she has concerns regarding Section 30. Assumption of REMSA Central Facility by aFuture Contractor, "and the assumption ofthese assets and debts." Stated, as aBoard member "she does not know what financial decisions are being made to take on debt and assets; and should that [REMSA] fail then those debts and assets come back on the Board of Health and ultimately the jurisdictions."WASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING August 25,2011 Page 10

Stated, "these are the majDrfive (5) SectiDns forwhich she has concerns; that there is aclause, which allDws for mutually agreed upon amendments to the Franchise Agreement." Stated, "between now and March 2012 when the Compliance RepDrt is presented, perhaps there can be discussiDns as to any opportunities to open dialogue with the Franchisee to Dbtain that information."
Dr. Hess Stated, "regarding the CDncern specificto debts and assets; that as the Health Officer receives the annual repDrt from the agency and the 990," he would question ifthis infDrmation "is shared with the BDard of Health members."
In response to Dr. Hess Ms. CoulDmbe advised "that information is provided to the District Health Officer; and REMSA has an annual external audit performed every year."
In response to Dr. Hess Regarding the 990 "not being provided to the Board Df Health members", Ms. Leslie Admirand, Deputy District Attorney, advised her legal opinion is "there are documents which are public record and other documents, which contain proprietary business infDrmation that is not part Dfthe public record. Ms. Admirand advised, when information contains proprietary [business] infDrmation it is confidential; that this information is cDnfidential by law; and therefore, nDt available to the public."
In response to Dr. Hess Chairman Smith Advised the Health Officerand the Administrative Health Services Officer"are privileged tothe information ofthe audit and the 990, and review ifforthe BDard of Health"; that the Health Officer and the AHSO then advise the Board of Health as to the cDmpliance with the requirements ofthe Franchise Agreement.WASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING August 25, 2011 Page 11

Dr. Iser Stated, he will conferwith Ms. Admirand and representatives of REMSA to discuss "whatformation could possibly be provided to the Board of Health members. MOTION: Dr. Hess moved, seconded by Dr. Humphreys, thatthe Washoe County District Health Department's Franchise Compliance Report forthe Regional Emergency Medical Services Authority (REMSA) for July 1, 2009 through June 30, 2012, be approved. Motion carried unanimously.

REVIEW
- ACCEPTANCE
- MONTHLY PUBLIC HEALTH FUND REVENUE AND EXPENDITURE REPORT
- JULY2011 Ms. Coulombe Advised the Board members have been provided with acopy ofthe Health Fund Revenue and Expenditure Reportfor the month ofJuly2011. She reviewed the Report in detail advising Staff recommends the Board accept the Report as presented. MOTION: Me. Gustin moved, seconded by Dr. Humphreys, that the District Health Department's Revenue and Expenditure ReportforJuly2011 be accepted as presented. Motion carried unanimously.

UPDATE
- FISCAL YEAR 12- POSSIBLE DIRECTION TO STAFF Dr. Iser Advised Staffhas submitted the District's 10% budget reduction plan to the County; that Staffdoes not anticipate any additional budget reductions specific to the Countytransfer. Stated, the Board of County Commissioners made the determination notto approve a 1 

### %increase to the motorvehicle license fee to "help fund the Incline Village refunds." Stated, the County has indicated monies from adiscretionaryfund will be utilized to payforthe refunds; that the County will then "request reimbursementfrom the othertaxing entities." Stated, there is alevel ofdisagreement among the County Commission members and the othertaxing entities as to who should pay the interest due.WASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING August 25, 2011 Page 12

Ms, Coulombe Advised, the 10% budget reduction plan presented to the Board of Health last month is the plan, which was submitted to the Board ofCounty Commissioners, Stated, Staffhad anticipated the requestfor areclassification within the AirQuality Management Division, from aPublic Information Officer (PIO) to an Air Quality Specialist, would be on the BCC agenda forAugust 23rd; however, it was not. Stated, the 10% budget reductions plans will be presented bythe various County Departments at the Board ofCounty Commissioners September27, 2011 meeting; that Staffwill have that update available forthe Board's OctoberStrategic Retreat. Dr, Hess Stated, he has met with three (3) ofthe five (5) Division Directors for his orientation; that "foras bad and depressing as the [budgetary] news is, he has been very impressed with the level of enthusiasm" and the strategies for providing services with reduced funds,
No action was taken,

PUBLIC HEARING
- WASHOE COUNTY DISTRICT BOARD OF HEALTH REGULATIONS GOVERNING PULIB BATHING PLACES AND PUBLIC SPAS 1

:OOp,m,: This being the time set in aNotice of Public Hearing, heretofore published in the Reno Gazette Journalon May20,23, and June 1,2011, to considerthe additions to the District Board of Health Regulations Governing Public Bathing Places and Public Spas, A. Presentation and Discussion of Proposed Additions to Section 010 (Definitions), Section 020 (Public Bathing Places and Spa Operator Requirements): and Section 030 (Enforcement Actions) Mr. Bryan Tyre, PE, Acting Senior Reqistered Engineer Advised the Environmental Health Services Staffconduct all ofthe inspectionsforthe public pools and spas within the County; that Staffconduct approximately 1200 inspections annually. Advised, Staffcan manage the 1200 required annual inspections; however, there are "a numberof unanticipated return 'Inspections due to complaints or lackofcompliance to the Regulations,WASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING August 25, 2011 Page 13

resulting in the closure ofpools and multiple inspections." Advised, Staffprepared draft Regulations requiring operators ofpublic pools and spas to have aCertified Pool/Spa Operator (CPO) on staff.
Mr. Wes Rubio, Environmental Health Specialist Advised, itwas the consensus ofStaff it was anecessaryto address the issue of public health and safety in regard to public swimming pools and spas; thatwithin the past twelve (12) months it has been necessaryfor Staff, on multiple occasions, to close the pools and/orspas at three (3) ofthe majorcasinos to protect the public health. Advised, Southern Nevada has successfully required aCPO (Certified Pool Operators) program for all pool and spa operators for "the last twenty (20) years"; that he reviewed Southern Nevada's CPO Program and adapted itfor Washoe County. Advised the requirement for aCPO ensures an individual has aminimum levelofeducation; and extends the levelof responsibility foroperating a pool orspa to the permit holder/managementcompany ensuring there is an individual certified in the proper management and maintenance ofapublic pool orspa. Stated, the proposed provisions requiring aCPO will benefitthe community, the Health District, and the permit holders/managementcompanies.
As indicated there were two (2) options available to Staff
- additional inspections resulting in increased permitfees to payfor the necessary additional staffing; or achieving agreater level of compliance through requiring Certified Pool Operators foreach facility. Advised the Regulations specify athree (3) year recertification program forthe CPOs. Advised, Staff recommends the Board approve and adopt the proposed additions to the Regulations as presented.
In response to Mr. Gustin Regarding "a percentage of repeat offenders compared to the 1200 inspections peryear", Mr. Rubio advised Staffdoes not have that information; that itwould require the assistance if ITto determine those percentages. Mr. Rubio advised the "re-inspections are notjustfrom complaints; that apercentage are the result ofStaffinspections determining the pool orspa is not in compliance. Mr. Rubio reviewedthe inspection process forannual and seasonal pools and spas.WASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING August 25, 2011 Page 14

Mr, Bob Sack, Director, Environmental Health Service Advised, approximately ten (10) years ago Staffwas conducting pool inspections "once amonth"; that due to fewer Staffmembers, budget reductions and the increased numberofpools and spas the District only has the capacity fortwo (2) annual inspections, Stated, with the decrease in the numberof inspections, Staffhas noted acorrelated increase ofapproximately 100complaints annually, Advised, Staffhas noted "the same recurring complaints at anumberofthe same facilities; that anumberofthe complaints are the result of not having properlytrained operators at the pools and spas," Advised, increased inspections "is not the answeras that results in Staffcontinually educating the individual operating the pool at that time"; that there are acouple of local companies which offer the national certification training for pool operators, Advised, upon submission ofdocumentation, Staffwill issue the three (3) year Certificate to the Pool Operator(s), Stated, the Certified Pool Operators (CPOs) "will then be responsible forthe maintenance ofthe pools and spas at those facilities which contractwith them," Stated, it is the consensus ofStaff "this will decrease the numberofcomplaints being received, thus reducing the numberof repeat violations requiring repeat inspections,"
In response to Mr, Gustin Regarding the proposed requirement being for all facilities "ratherthan justthe repeat offenders", Mr, Sack advised "what Staffhas noted is an across-the-board drifting away offrom the ability of these facilities to remain in compliance" throughout the season orannually, Advised, Staff is attempting "to reverse anoted trend forall pools and spas", which are inspected,
In response to Mr. Gustin Regarding adifference in "saline pools versus the chemically treated pools", Mr. Rubio advised "both types ofpools utilize the same type ofsanitizer, which changes through achemical process to chlorine," Advised, in regard to compliance, "the issues are the same; thatthe individual(s) operating the pools orspas don't always have the knowledge necessaryto maintain the pool/spa in asanitary manner, which will serve the community and not place otherpeople at-risk," Mr, Sack Stated, to convert acommercial pool from chemical to saline requires "a dramatic change in equipment and sizing; that there are problems trying to convert as it requires aredesign toWASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING August 25, 2011 Page 15

accommodate the cell generators," Stated, although there has been some interested indicated, Staffhas not noted anumberofcommercial pools converting to saline; however, "ultimatelythe chemistry is the same," Mr, Gustin Stated, he would commend Mr, Rubio for assisting in "getting apool at amajorcasino reopened during the Memorial Dayweekend, after he, as aReno City Councilman, had received atelephone inquiry about it." Stated, he is aware "Mr. Rubio and other Staff members made the extra effort when the facility in question was not in compliance; that Mr. Rubio's efforts were overand above what was required; that he appreciates those efforts,"
In response to Chairman Smith Regarding the difference between "saline pools versus chlorine pools", Mr, Rubio advised that saline pools will have "more total dissolved solids as solid salt is added to the water," Stated, the commercial saline pools ofwhich he is aware, are adding fifty-five (55) pound bags ofsalt two (2) orthree (3) times perweek depending upon the level of usage, Stated, on "hot days of heavy usage ofthe pool the operator may be adding one-hundred (100) pounds every two (2) orthree (3) days, which increases the total levels ofsolids resulting in the water becoming milky, This requires draining more frequently orshutting-down to treat it and maintain service," Stated, regardless of the type ofsystem, "it depends on how good the operator is; that the proposed additions to the Regulations address these issues," Advised, Staffwill continue to conduct two (2) inspections ofevery commercial pool and spa; that the proposed amendmentwill require afacility with apool orspa to have aCertified Pool Operator (CPO), who will be responsible forthe maintenance ofthe pool and/orspa, Advised, this Program will be similarto Certified Food Service Managers; thatdocumentation will be provided to the Health Department that an individual successfully completed anational CPO training; the Health District will issue abadge identifying the individual as an authorized CPO, Advised the CPO will have the ability to obtain aform from the Health Districtwebsite, which will be posted eitherin the pump room orsomewhere on the premises, with the name and contact information should a problem occurand it is necessary forStaffto contact them; that this individual "will not be required to be on-site when Staffconducts the inspection(s)," Advised, this provides Staff "with a responsible party to contactwhen necessary,"WASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING August 25,2011 Page 16

B, Recommendation to Approve and AdoptAdditions to the Washoe County District Board of Health Regulations Governing Public Bathing Places and Public Spas Chairman Smith declared the Public Hearing open and called upon anyone wishing to speak either in favoroforopposition to the proposed additions to the Washoe County District Board of Health Regulations Governing Public Bathing Places and Public Spas, specific to the requirements for Certified Pool Operators, Mr, Doug Coulter, PE, Retired Senior Engineer Advised, "since 1974, the existing Regulations have required qualified staffto operate pools and spas; that the proposed addition establishes the standards forthose qualifications," Stated, the proposed addition to the Regulation will result in "improving the efficiency ofStaffin conducting the inspections without having to sacrifice the quality ofthe inspections," Advised, requiring aCPO will allow Staffto more immediately address an issue of non-compliance; and how and when that issue will be resolved, Advised, when the Health District had the capacity to conduct monthly pool inspections "itwas a matterofoperation by inspection -- Staffwould provide alist of issues that had to be corrected and then return the following month to determine ifthe deficiencies had been corrected," Advised, with the reductions to two (2) annual inspections Staffdetermined "it was notenough contactwith the operators; and there was concern as to what was occurring the remaining 363 days," Advised, the proposed addition is "modeled afterthe Certified Food Service Manager Program to ensure the pools and spas are operated properly 365 days ayear," Stated, as Mr, Sack advised, previously when Staffconducted monthly inspections the EHS division would receive approximately adozen complaints ayear; thatwhen itwas reduced to two (2) annual inspections complaints increased to approximately 100 annually, with amarked increase everyyear.
Mr. Coulter reiterated the approval and adoption ofthe additions to the Regulations "will improve Staffefficiency and ensure the public health, Mr, Richard Martinache, Vice President of Lee Joseph Pools and Swim Pool and Spa Consultants Advised, he is aCPO instructor in the community, certified bythe National Swim Pool Foundation (NSPF); that his father, Mr. George Grukovic, has been offering the CPO program in the community since 1987, and has trained in excess of2500 CPOs, Stated, the NSPF "has been theWASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING August 25, 2011 Page 17

leaderofthe industry since 1974; that he would encourage people to visit the NSPF website for more information. Stated, NSPF fully supports the requirement ofcertifying and registering pool operators with the local health departments. Stated, "in regard to public safety he teaches the standard of having asafe pool is extremely important, as the public expects pools to be safe from disease, illness, and harm." Stated, Swim Pool and Spa Consultants offers four (4) certification classes peryear in Reno and Las Vegas; that Swim Pool and Spa Consultants provide continuing education to the CPOs. Stated, he would commend Stafffor proposing the addition to the Regulations; that "it will continue to keep the public safe."
Mr. Sack Stated, he would commend Mr. Grukovicfor his contribution to public safety in offering the pool and spa certification courses; that all EHS Staffhave completed Mr. Grukovic's courses priorto inspecting swimming pools and spas.
There being no one else wishing to speak either in favorofor in opposition to the proposed additions to the Regulations, the Public Hearing was closed.
Dr. Humphreys Stated, he would question ifthere is afee charged for re-inspections oraprocess forallowing a charge for re-inspections.
In response to Dr. Humphreys Mr. Rubio Advised, the annual fee forthe Permit to Operate includes the initial opening inspection for seasonal pools; and the secondary routine inspection; and the two (2) inspectionsforannual pools. Advised, there are provisions for billing for re-inspection fees; that are-inspection fee cannot be levied if apool orspa is not in compliance during the initial opening inspection and itis necessary for Staffto return to conduct are-inspection. Advised, there have been facilities in which it was necessary for Staffto conduct "six (6) inspections during the operating period. There are facilities which have more than one (1) pool orspa; that, again, itthen becomes an issue ofeducation;" that ifthere is non-compliance with one (1) pool orspa there will (probably) be non-compliance with allWASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING August 25, 2011 Page 18

ofthe pools and spas. Stated, "it becomes acontinual problem; that it becomes an issue of having aminimal level ofeducation and knowing how to properly operate the equipment and understanding the waterchemistry."
In response to Chairman Smith Regarding inspecting facilities with more than one (1) pool orspa, Mr. Rubio stated Staffdoes attempt to schedule the inspection ofall the pools and spas at the same time forthose facilities with more than one (1) water body. Advised, Staff has now classified pools and spas by zip codes to more efficiently conduct the opening and routine inspections resulting in saved Stafftime and cost savings to the Department.
In response to Ms. Ratti Regarding the majority of re-inspections being due to "failed inspections oracomplaint", Mr. Rubio advised the majority have been due to failed inspections; however, the numberofcomplaints has greatly increased; and Staffdoes respond to complaints. Advised, the majority ofcomplaints are "the visibility ofthe waterorthe chlorine bleaching-out the swimsuits; thatthe public won't be aware'ofchemical imbalances and improper levels." Stated, Staff's concern has been "the individuals operating these facilities being unaware these are issues ofconcern and pose ahealth threat;" that the proposed addition to the Regulations will address this and will result in the protection ofthe public. MOTION: Mr. Gustin moved, seconded by Ms Ratti, that the additions to the Washoe County District Board of Health Regulations Governing Public Bathing Places and Public Spas, be approved and adopted as presented, Motion carried unanimously,

PUBLIC HEARING
- WASHOE COUNTY DISTRICT BOARD OF HEALTH REGULATIONS GOVERNING SOLID WASTE MANAGEMENT A. Presentation and Discussion of Proposed Deletion ofSection 090.000 - 090.195, Inclusive (Land Disposal Facility): B. Presentation and Discussion of Proposed Additions to Section 010 (Definitions), Specifically Section 010.010 (Active Portion); Section 010.022 (AnnularSpace); Section 010.086 (Bird Hazard); Section 010.146 (Composite Liner); Section 010.278 (Face Amount); Section 010.438 (Lower Explosive Limit): Section 010.538 (Period for Repayment into Fund): Section 010.618 (Salvage Yard): Section 010.734 (Type IError); Section 010.754 (Washout); SectionWASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING August 25, 2011 Page 19

010.762 (Waste Management Unit Boundary); and Section 090,001 - 090,557, Inclusive (Landfill/Municipal Solid Waste Landfill Unit); C, Presentation and Discussion of Proposed Amendments to Section 010 (Definitions), Specifically Section 010.408 (Lateral Expansion); and Section 010.428 (Liguid Wastes) 1

:OOpm: This being the time set in aNotice of Public Hearing, heretofore published in the Reno Gazetle Journalon July 12, 14, and 21, 2011 to considerthe proposed deletions, additions and amendments to the Washoe County District Board of Health Regulations Governing Solid Waste Management. Mr, Jim English, Senior Environmental Health Specialist Advised, that the Board members have been provided with acopy "of acomplete update to the landfill portion ofthe Washoe County District Board of Health Regulations Governing Solid Waste Management." Advised, "the proposed deletions, additions, and amendments are the complete revision ofthe Solid Waste Management Regulations, with the exception ofthe definition of garbage," Stated, the proposed Regulations parallel the State, and are easierforthe public to comprehend; that Staff recommends the Board approve and adoptthe proposed deletions, additions, and amendments to the Regulations be approved and adopted as presented, Stated, the approval and adoption ofthe proposed revisions will ensure the District's Regulations are as stringent as the State's,
In response to Dr. Humphreys Regarding, "currently there being no fiscal impactto businesses", Mr, English advised the Health District does have the authorityto charge fees for plan reviews and Permit to Operate; however, currently there are no landfills in the Washoe Health District. Stated, "Staffdoes not anticipate any landfills being designed orconstructed in the Health District orCounty in the nearfuture,"
0, Recommendation to Approve and Adopt the Additions, the Amendment and Deletions to the Washoe County District Board of Health Regulations Governing Solid Waste Management Chairman Smith declared the Public Hearing open and called upon anyone wishing to speak either in favorofor in opposition to.the proposed revisions to the Washoe County District Board of Health Regulations Governing Solid Waste Management.WASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING August 25, 2011 Page 20

Mr. Greg Martinelli, Waste Management, Inc. Stated, he would commend Ms. Jeanne Rucker and Mr. Jim English, of Environmental Health Services; that "it was apleasure working with them on developing the revisions to the Regulations." Stated, Waste Management, Inc. supports the adoption ofthe proposed revisions. There being no one else wishing to speak either in favorofor in opposition to the proposed revisions the Public Hearing was closed. MOTION: Dr. Humphreys moved, seconded by Dr. Hess, that the proposed deletions, additions and amendments to the Washoe County District Board of Health Regulations Governing Solid Waste Management, be approved and adopted as presented. Motion carried unanimously.

PUBLIC HEARING
- WASHOE COUNTY DISTRICT BOARD OF HEALTH REGULATIONS GOVERNING SOLID WASTE MANAGEMENT Chairman Smith advised this item has been withdrawn forfurther revision and will be rescheduled forthe Board's October27,2011 meeting.

PUBLIC HEARING
- STATE IMPLEMENTATION PLAN (SIP) A. Presentation and Possible Discussion ofthe Revision to the Washoe County Portion of the Nevada State Implementation Plan (SIP), Which Demonstrates the Washoe County Health District's Compliance with the Lead Infrastructure SIP Requirements ofthe CleanAir ActSection 11O(a )(2) 1

:OOpm: This being the time set in aNotice of Public Hearing, heretofore published in the Reno GazetteJournalon July22; August 10 and 22, 2011, to considerthe revisions to the Washoe County portion ofthe Nevada State Implementation Plan (SIP), demonstrating the Health District's compliance with the Lead Infrastructure SIP Requirements ofthe CleanAirActSection 110(a)(2). Mr. Daniel Inouye, AirQuality Specialist Advised, the CleanAirActmandates the US Environmental Protection Agency (EPA) established health-based National AmbientAir Quality Standards (NAAQS) forsix (6) criteria air pollutants, including lead.WASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING August 25, 2011 Page 21

Advised, nationwide average concentrations of Lead in the air have decreased by 94% since 1980; that the majority ofthis improvementwas the result ofthe phase-out of Lead in gasoline, Advised, in 2008, EPA issued afinal rule revising the Lead Standard, which initiated specific Clean AirAct requirements including the Infrastructure State Implementation Plan (i-SIP), Advised, the I-SIP is asummary ofcurrent airquality management elements in Washoe County's portion ofthe Nevada Lead SIP, which includes airquality regulations and programs, demonstrates the Health District's ability to comply with the requirements ofthe CleanAirAct, Advised, the EPA rule requires source-oriented ambient monitoring for non-airport Lead sources emitting 0,5 tons annually and airport sources emitting 1,0 tons peryear. Advised, currently there are no sources in Washoe Countywhich "meet those criteria; and the Division does not currently monitorfor Lead, Advised, Staff recommends two (2) minorrevisions to the I-SIP; including the Nevada Division of Environmental Protection (NDEP) recommendation to revise the title to read: "The Washoe County Portion ofthe Nevada State Implementation Plan to Meetthe Lead SIP Requirements ofthe Clean AirAct Section 110(a)(2)," Stated, "specifying it is Washoe County's Portion ofthe SIP will assist the NDEP and US EPA as other areas ofthe state submit their portions," Stated, the second revision is specific to Table 1; that the threshold source-oriented monitoring "at airports is 1,0ton peryear"; however, this is incorrectly listed and will be corrected "on page 2, Element B, paragraph 2, line 2; and on page 5, Element G, paragraph 1, line 3," Stated, Staff recommends approval and adoption ofthe Lead I-SIP, with the recommended revisions; that upon adoption and approval itwill be forwarded to the NDEP, Stated, the NDEP will formally I-SIP to the US EPA as arevision to the Washoe County Portion ofthe Nevada Lead SIP, B, Recommendation to Approve and Adopt the Revision to the Washoe County Portion of the Nevada State Implementation Plan (SIP), Which Demonstrates the Washoe County Health District's Compliance with the Lead Infrastructure SIP Requirements ofthe CleanAir ActSection 110(a)(2) Chairman Smith declared the Public Hearing open and called upon anyone wishing to speak either in favoroforin opposition to the proposed revision to the Lead Infrastructure ofthe Washoe County Portion ofthe State Implementation Plan (SIP), There being no one the Public Hearing was closed, MOTION: Ms. Ratti moved, seconded by Dr. Humphreys, that the Revision to theWASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING August 25,2011 Page 22

Washoe County Portion ofthe Nevada State Implementation Plan (SIP), demonstrating Washoe County Health District's Compliance with the Lead Infrastructure (SIP) Requirements ofthe Clean AirAct Section 110(a)(2), be approved and adopted as presented. Motion carried unanimously.

STAFF REPORTS AND PROGRAM UPDATES 

### A. Director
-- Epidemiology and Public Health Preparedness Dr. Randall Todd, Director, Epidemiology and Public Health Preparedness, presented his monthly Division Director's Report, acopy ofwhich was placed on file for the record.
Dr. Todd Advised the Board laboratory tests confirmed Washoe County's first case ofWest Nile Virus forthe season; that "due to the unusuallywet and protracted wintercreating an ideal environment for mosquitoes." Stated, Staffhad anticipated a"more severe WNV season"; however, "that has not occurred due to the effectiveness ofthe Vector Control activities." Stated, the Health District was advised ofthe confirmed case through the blood donorscreening program; that this individual had traveled through Idaho, California and Nevada; therefore, it is not known where he may have contracted the Virus. Advised, Vector Control Staffhave obtained mosquito samples in the "area adjacent to this individual's residence; that these mosquitoes have been tested; and the results are pending."
Dr. Iser Advised, the Health District has issued apress release to inform the public ofthis case; and the protective measures to takefor prevention ofthe West Nile Virus.
Dr. Todd Stated, the press release was issued; that immediately priorto the meeting news Channels 2and 8 were on-site conduct interviews; that Dr. Furman indicated he heard the information on the radio on his way to the meeting.WASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING August 25, 2011 Page 23

B, Director
- Community and Clinical Health Services Ms, Mary-Ann Brown, Director, Community and Clinical Health Services, presented his monthly Division Director's Report, acopy ofwhich was placed on file for the record, Ms, Brown Advised, each ofthe Board members was provided with the brochure/agenda forthe Obesity Forum, scheduled forThursday, September8,2011; that she would invite the Board members to attend, Stated, Staffanticipates an increased attendance at this year's event. Stated, Dr, Iserwill be providing the opening comments, Stated, Dr, Hess has completed his orientation with the CCHS Division; that she would thank him "forbeing very tolerant ofStaff's passion for the Division Programs, Staffwas very appreciative of his taking the time to learn about the Programs in CCHS,"
In response to Dr. Humphreys Regarding back-to-school immunizations and "ifStaff anticipates an increase oradecrease in the numberseeking immunizations, Ms, Brown stated, "forthe past numberofyears Staffhas attempted to anumberof methods to engage the parents, the School District, and the community to be prepared forschool entry, especiallyfor 7th grade," Stated, Dr. Iserand Staffmet with representatives last week to discuss the immunization requirements and were advised there were approximately 2400 students who had notyet been fully immunized forschool entry, Stated, Staff is aware "there are systems issues, including the timely entry of immunization records into the WeblZ database; and the school districtverifying those immunizations," Stated, the numberof students who have notyet been immunized has been reduced, including approximately 600 seventh graders, Stated, the Health District and the School District, through the media have been promoting the immunization clinics, "not onlythe Health District clinics, but others in the community as well." Stated, the Nevada Immunization Coalition "has been making personal telephone calls to parents reminding them of immunization requirements and those not in compliance will be excluded from school." Advised, the Health District will be conducting awalk-in clinic; that Saint Mary's has walk-in clinics; that UNR Medical School Clinic "has tried to fill the gap forthe Orvis Nursing School Clinic; thatthere are other community sites conducting clinics; that the Nevada Immunization Coalition issued apress release yesterday listing the various clinic locations,WASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING August 25,2011 Page 24

Dr. Humphreys Questioned, "if it is the policy to exclude children from school ifnot properly immunized."
In response to Dr. Humphreys Dr. Iser Advised, children not properly immunized will be excluded from school. Stated, with the implementation ofthe Tdap (Tetanus, Diphtheria, and Pertussis) requirement two (2) years ago for seventh graders, and atthe request ofthe School District, the Health District allowed aperiod of exemption for those children who weren't in compliance to obtain the Tdap without being excluded. Advised, there will be no exemption period this year; that "it is the role ofthe Health Districtto protectthe public health
- protecting those who can't protect themselves." Stated, in his capacity as the Health Officerin Nevada County there was athirty (30) day old infantwho died from Pertussis.
Ms. Brown Advised, the exemptions granted in the past two (2) years was in an effort "to achieve the mutual goals ofensuring all children were immunized to protectthe public's health, while ensuring exclusions were minimized, as that has adetrimental effect as well." Stated, the community "worked collaboratively to ensure these dual goals were met- children being properly immunized and being in school." Stated, she and Dr. Iser"were in complete agreement as to this year's process."
Dr. Iser Stated, immunization Staff "anticipates afull daytomorrow and afull dayon Saturday, as Ms. Brown's Staffwill be conducting aclinic tomorrow; that Staffanticipates afull day Monday, as children are excluded from school."
Ms. Brown Advised, Saturday's clinic is a"walk-in clinic."WASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING August 25, 2011 Page 25

Dr. Hess Stated, when Dr, Mary Guinan was the State Health Officer, an Immunization Advisory Committee was established through the State Health Division, which made the recommendation ofschool admission to ensure proper immunization, Ms, Brown Stated, "when the Tdap requirementforseventh graders was implemented, Southern Nevada excluded hundreds ofchildren from school; that Staffattempted to work collaboratively with the School District and the community providers to achieve the dual goals," Stated, lastyear Staffwas very pro-active in ensuring seventh graders received the Tdap, including "having strike teams go to the schools and immunize those children who were deficient; that there were approximatelythirty (30) children who weren't immunized bythe strike teams orthrough otherefforts,"
In response to Dr, Humphreys Regarding the incident at aprivate school, Ms, Brown stated the incident at the private school was aresponse to an outbreak and not related to the Tdap immunizations efforts forseventh graders, Dr, Iser Stated, allowing personal exemptions from immunization requirements "sets-up the risk for significant outbreaks; that he appreciates being in an area that does not allow for personal exemptions,"
C, Director
- Environmental Health Services Mr. Bob Sack, Director, Environmental Health Services, presented his monthly Division Director's Report, acopy ofwhich was placed on file forthe record,
Mr. Sack Stated, the upcoming week is "one ofStaff's busiest weeks for special events; that Staffwill be working the Rib Cook-Off; and the BurningMan event." Advised, the Vector Control Team continues to be "very busy, as there is alot ofwater and alotofbugs,"WASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING August 25, 2011 Page 26

Dr. Humphreys Stated, "a gentleman on the Red Hawk Golf Course complimented the Vector Staff indicating 'he had not had one mosquito bite this year'; that "that goes to Staff's efforts."
Mr. Sack Stated, Staff is "working to control the populations; that Staffhas noted mosquitoes in places where there previously wasn't any."

D. Director
- Air Quality Management Mr. Kevin Dick, Director, Air Quality Management, presented his monthly Division Director's Report acopy ofwhich was placed on file for the record.
Mr. Dick Advised, the Fundamental Review Report was presented to the Board ofCounty Commissioners; that arecommendation in the Report indicated "as the Air Quality Management Division does permits and conducts inspections, the AQM Division should be combined with the Building Department and others which issue permits and conduct inspections." Stated, each month AQM Staff reports the numberofpermits issued and inspections conducted; however, he has not "explained what the permits are fororwhatthe inspections involve." Advised, the permits issued byAQM are based "on one (1) oftwo (2) types of Regulations. The US EPA establishes National AmbientAir Quality Standards (NAAQS), which are designed forthe protection ofpublic health. When these Standards are issued AQM develop plans delineating how the District will attain and/or maintain that public health Standard. To achieve this Staffdevelops control measures, some ofwhich are permit requirements forsources ofair pollutants limiting the amount ofemissions, which can be released into the ambient airthateveryone breathes. These Regulations are established by the local ordinances through the State Implementation Plan (SIP) process, which are submitted to US EPA for approval; that the local Regulations then become federally enforceable Regulations." Advised, "the othertype ofpermits issued by AQM are for Regulations developed at the federal level by US EPAfor hazardous air pollutants orspecifictypes ofairpollution sources; that the USWASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING August 25, 2011 Page 27

EPA then directly delegates theAQM Districtwith the authority to regulate and permit those sources. The US EPA specifically empowers the AQM Division ofthe Washoe County Health Districtwith the compliance and enforcement authority forthese Federal Regulations. Advised, "the statistical permit information provided in the monthly Report relates to the permits issued by the AQM Division." Advised, "the majority ofthe more than 1200 annual permits issued, are Permits to Operate forcontinuous business operations and are not related to new construction and development activities. These businesses are outside the authority ofWashoe County and are not regulated by the Washoe County Building Department, as 60% ofthe sources are located in Reno; approximately 30% are located in Sparks, with the remaining 10% in Washoe County." Advised, the inspections performed byAQM Staff, as noted on the bottom ofpage three (3) "are fundamentally differentthan an inspection performed bythe Building Department. The Building Department schedules inspections with the contractorordeveloperofconstruction projects to determine ifproject is being constructed in accordance with building standards." Stated, when "AQM Staffconducts an inspection it is unscheduled and is forthe purpose ofobserving how a business is operated and how harmful air pollutants, which are being emitted, are being controlled in accordance with the conditions stipulated in the Permit to Operate." Stated, Staffinspections review "how employees [ofasource] are performing theirjobs; ifthe employees have documentation of required training; the chemistry ofthe materials being handled in the business; the amountofchemicals being used; the equipment being used in the processes; operational hours; and the pollution control equipment that is in place ensuring it is installed properly and operating efficiently." Advised, the AQM inspectors are "highlytrained on anumberofvarious EPA Regulations and requirements. The inspectors have required medical monitoring and personal protective equipment training to be able to suit-up and entercontaminated airspaces when necessary." Advised thejob functions "are fundamentally differentthan what abuilding inspectorwould do." Stated, page five (5) ofthe monthly Report delineates the various types of "complaint activityto which Staffresponds." Advised, he continues to participate in "on-going discussions with the permitting and compliance departments to review streamlining efficiencies on howto best function togetherwith the other Departments." Stated, the Fundamental Services Review referenced "proposed consolidation on efficiencies and howto reduce services in away which would save money in the operations." Stated, aproposal was to made in the County compliance and permitting workgroup to eliminate "somebodyWASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING August 25, 2011 Page 28

answering the telephone having calls transferred to voice mail all day; and at the end ofthe day checking calls." Stated, AQM Staff"respond to complaints from citizens who feel they be being exposed to air pollution; that Staffattempt to respond within an hourof receiving the complaint." Staffinvestigates these complaints "and takes action as necessary and reports back to the complainant so the complainant knows Staffresponded and what action, ifany, was taken." Stated, "this is very importantfor people's peace of mind when there is aconcern their health is being impacted by activities which are occurring."

E. Administrative Health Services Officer Ms. Eileen Coulombe, Administrative Health Services Officer, presented her monthly Administrative Health Services Officer Report, acopy ofwhich was placed on file for the record.

F. District Health Officer Dr. Joseph Iser, District Health Officer, presented his monthly District Health Officer's Report, a copy ofwhich was placed on file forthe record.
Dr. Iser Stated, he continues to meet with representatives ofthe various agencies and entities throughout the Cities and the County. Stated, his report delineates the various media contact and with which media the contactwas. Stated, the Board members have been provided with acopy of his written response to the Board of County Commissioners and Ms. Simon, on behalfofthe Health District, regarding the recommendations ofthe Fundamental Services Review. Stated, "in spite ofStaffs best effortsthey were unable to sway Management Partners from presenting recommendations to the Organizational Effectiveness Committee (OEC), which were presented to the Board ofCounty Commissioners; that the AirQuality Management Division and Environmental Health Services transferred to the new Municipal Services Department." Stated, he provided the Board members with acopy of anewspaperarticle from the Reno Gazette Journal, regarding the proposed new County Department. Stated, he has explained "he does not have the authority to transferthese two (2) Divisions anywhere outside ofthe Health District without many levels ofapproval, first and foremost the approval ofthe District Board of Health." Stated, as "Mr. Dick indicated, [the Health District] has many regulatory agencies ensuring the Health District does itsjob, including the State,WASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING August 25,2011 Page 29

US EPA and other agencies. There would have to be an entire series of approvals after a determination bythe Board of Health." Advised, the Board members have been provided with agraph, which delineates the status of completed evaluations for Health District Staff; that afterevaluations are current, Staffhas established agoal of85% compliance. Stated currently the Health District has completed approximately 74% ofthe evaluations, improving from approximately 40%. Advised, the Board of County Commissioners have released the contract forareview ofthe "entire EMS system, including the pre-hospital care, in which REMSA "plays amajor part and fire plays a part." Stated, he is in the process of "meeting with as many people as he can to obtain as much information as possible to develop his own beliefs regarding the EMS system." Stated, "he did volunteerto be aco-project officeron the EMS Study, forfirst responder and medicine, as amore neutral party because he is newto the County; and he has some experience in this area. He offered his services to Mr. Kurt Latipow, Fire Liaison with the County and Ms. Simon County Manager; that he as advised his services weren't needed as co-projectofficer; however, they would like him involved as he could." Stated, "he will remain as neutral an arbiteras he can in this process." Stated, the District Board of Health's function is "to oversee the Franchise Agreement and to ensure compliance with thatAgreement."

BOARD COMMENT There was no Board comment presented.

PUBLIC COMMENT There was no public comment presented.WASHOE COUNTY DISTRICT BOARD OF HEALTH MEETING August 25, 2011 Page 30

There being no further business to come before the Board, the meeting was adjourned at 3:05pm.

JOSEPH P. ISER, MD, DrPH, MSc DISTRICT HEALTH OFFICER/SECRETARY

# (?3~f,)~(~**.i;\SW;~\** JANET SMITH, CPS RECORDER