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°"!" 2 Body Art Inspeco Report Date:9 - /3- �L� <br /> o co <br /> San Joaquin County Environmental Health Department Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: <br /> `p. (209)468-3420 Program <br /> www.siogv.org/ehd g UI n <br /> a <br /> Element: I <br /> PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> 537527 Paul Marquez <br /> 537697 Joe Swanson <br /> 537528 Joel Ruiz <br /> 536982 Bao Nguyen <br /> Observations and Corrective Actions: <br /> 1. Each sterilization load shall be monitored with mechanical indicators for time, temperature and pressure, Sterilization shall be <br /> accomplished by steam autoclave, manufactured for the sterilization of medical instruments, and pass a Class V integrator test. <br /> HSC 119315(b) <br /> -Class 5 integetrators do not clearly show a pass test. By next inspection employ class 5 integrators that indicate a pass test <br /> clearly. <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 /> -Request the following documentation from the manufacturer: Written proof on company or laboratory letterhead showing that <br /> the presterilized instruments have undergone a sterilization process. Written proof shall clearly identify the instruments sterilized <br /> by name or item number and shall identify the lot or batch number of the sterilizer run. <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 /> -Consent Forms must include the following statement <br /> Notice that tattoo inks, dyes, and pigments have not been approved by the federal Food and Drug Administration and that <br /> The health consequences of using these products are unkown. <br /> Unless otherwise noted, Corrective Action is due within 30 days. <br /> Reinspecion on/about: A reinspection fee of$125 per hour may charged. Page 2 of 2 <br /> EH-04/2014 <br />