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oA4`u!iy 'c. <br /> Body Art Inspection Report Date: June 24,2021 <br /> Q= {, San Joaquin County Environmental Health Department Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 <br /> Record: 4120 <br /> (209)468-3420 <br /> c ^ � www.s6oay.org/ehd Program <br /> qt' F' Rr'� Element: PR0524524 <br /> PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> PR0536982 Bao Nguyen <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)—A sterilization certificate was not available for the Lucky Supply needles <br /> with the lot#201220. Provide a copy of the sterilization certificate to the EHD. <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, touchless dispenser that is readily accessible to practitioner. HSC 119314(b)— <br /> The procedure area was not equipped with a wall-mounted, touchless paper towel dispenser.—Corrected on site. <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—The client records did not have the instrument lot#written or attached to them.— <br /> Corrected on site. <br /> Unless otherwise noted, correct and submit evidence of correction to the EHD by <br /> July 8, 2021. <br /> Note: <br /> 1. The inspection report was emailed to nicklang209(a�live.com. <br /> 2. Sharps Compliance is used as the mailback system for sharps waste disposal. It was last disposed on 6/20. <br /> 3. Bao is the only practitioner at the facility. <br /> 4. Ensure client records are kept for 3 years. <br /> Reinspection on/about: A reinspection fee of$152 per hour may be charged. Page 2 of 2 <br /> EH-11/17 <br />