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,°U Body Art Inspection Report Date: <br /> /yoF....,.....�o ,, <br /> N ?�, San Joaquin County Environmental Health Department Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: <br /> % (209)468-3420 <br /> •'�' `P, www.siogv.org/ehd Program <br /> Element: <br /> PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> PRO544224 Jesus Gariba (BBP posted,exp. 9/29/21 <br /> PRO537522 John Hullar BBP posted,exp 11/10/21 . <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)—The instrument lot numbers were not written or attached to the client <br /> consent forms. Ensure instrument lot numbers are either written on the client consent form or the empty package <br /> consisting of the lot number is attached to the client consent forms. <br /> Facility may open. <br /> Notes: <br /> 1. Inspection report emailed to operator at onetimetattoostudio(a-)gmail.com. <br /> 2. Post permit in a conspicuous place when received. <br /> 3. Client records from 2019 were reviewed. <br /> DATE: 2/25/21 PROGRAM RECORD: New PR# PROGRAM ELEMENT: 4120 <br /> Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Page 2 of 2 <br /> EH-11/17 <br />