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Body Art Inspects Report Date: <br /> 4 by l rin <br /> -� San Joaquin County Environmental Health Department Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: <br /> c .P.• (209)468-3420 <br /> Program <br /> <'.F7. www.sioov.org/ehd g <br /> Element: <br /> PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> PR0515393 Jon Highland PR0537376 Ne htali Bru ueras,Jr. <br /> PR0539346 Kristal Betancourt <br /> PR0537374 Ricardo Cardenas <br /> PR0537375 Shawn Edwards <br /> Observations and Corrective Actions: <br /> 6. A facility that uses single use instruments shall maintain record of purchase, log of procedures, names of practitioner and <br /> client, date of procedure, instruments used, and written evidence from the manufacture that the instruments have undergone <br /> sterilization. The record of purchase, evidence of sterilization, type and number of instruments used shall be maintained for a <br /> minimum of 90 days after use. HSC 119315(f) <br /> 11. The procedure area shall be equipped with a sink with hot and cold running water, containerized liquid soap, and single use <br /> paper towels dispensed from a wall-mounted,touch less dispenser that is readily accessible to practitioner. HSC 119314(b) <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 /> 19. At the completion of the procedure, the practitioner shall provide postprocedure instructions that include all elements listed in <br /> Form B. HSC 119308(b) <br /> 31. A body art facility shall be separated from any residential areas used for sleeping, bathing, or meal preparation and shall not <br /> share a common entrance or toilet facility with residence. The toilet facility must have a sink with hot and cold water, <br /> containerized liquid soap, and single-use paper towels that are dispensed from a wall-mounted, touchless dispenser. HSC <br /> 119314-The bathroom does not have hot water. A site visit will be conducted next Friday(51612016)to ensure that the <br /> bathroom does have hot water. If the bathroom does not have hot water by the site visit date,an automatic re- <br /> inspection will be conducted at a rate of$130 per hour. <br /> Unless Otherwise Noted, Corrective Action Due in 30 days. <br /> Reinspecion on/about: A reinspection fee of$130 per hour may be charged. Page 2 of 2 <br /> EH-03/2015 <br />