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,oPq„ Body Art Inspect Report Date: 6 1 <br /> y San Joaquin County Environmental Health Department Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: S Oy / I y✓ �1 <br /> c <br /> (209)468-3420• Program 1, <br /> www.siogv.org/ehd Element: I �2 <br /> D.E . <br /> Shannon Meder <br /> Observations and Corrective Actions: <br /> 18. The facilities client consent form and medical questionnaire must include all of the information listed in Form B, and are <br /> available for inspection. HSC 119303 <br /> Unless otherwise noted, violations must be corrected within 30 days. <br /> Notes: 1) Facility has been cleared to operate once permit has been paid for. <br /> 2) Proof presterilization must contain a lot#or other method to connect it to needles used onsite. <br /> Reinspecion on/about: A reinspection fee of$130 per hour may be charged. Page 2 of 2 <br /> EH-03/2015 <br />