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d Body Art Inspection Report <br />San Joaquin County Environmental Health Department <br />1868 E. Hazelton Ave., Stockton, CA 95205 <br />(209)468-3420 <br />P vamvsioav ora/ehd <br />PR Number <br />PRACTITIONER/ARTIST NAME <br />PRO542647 <br />Lisa Bates BBP exp. 3/31/22 <br />Observations. and Corrective Actions: <br />Number <br />Date: <br />Program <br />Record: <br />Program <br />Element: <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) —A sterilization certificate for the 7 mg Permanent Choices needle with lot <br />#VC6200 was not available. Provide a copy of the sterilization certificate to the EHD. <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 — Client records are not kept at the facility for 3 years. Ensure client records are kept <br />at the facility and available for inspection by the EHD. <br />Provide all corrections to the EHD by April 19. 2021. <br />Notes: <br />I. Inspection report emailed to owner, Lisa Bates at bzybates@gmail.com. <br />2. Facility/ practitioner permit received by the owner during the inspection. <br />3. An absorbent chair is located in the procedure room. The chair is further than 5 ft. away from the head of the procedure table. <br />4. The sharps waste is mailed back to Waste Management. <br />5. Ensure invoices and sterilization certificates are available for all instruments that are used at the facility for 90 days after <br />instrument usage. <br />6. Owner intends to digitalize client records in the future. <br />DATE: April 1, 2021 PROGRAM RECORD: PR0542646 � � J /PROGRAM ELEMENT: 4120 <br />Reinspecion onlabout: A reinspection fee of $152 per hour may be charged.../ Page 2 of 2 <br />EH -11/17 <br />