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Body Art Inspect Report Date: <br /> N % San Joaquin County Environmenta HeaM Department Program p� ss�b <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: <br /> (209)468-3420 <br /> . a www.siogv.org/ehd Program <br /> Element: <br /> PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> PR0537481 Geoff Rogers, BBP-CM 6/25/20 PRO543745 Robert Guzman, BBP-AT 4/8/2020 <br /> PR0538646 Billy Diaz,BBP AT7/16/20 PRO541774 Josh Palmer, BBP-CM 3/19/2020 <br /> ,PR0544277 regg,BBP AT 3/19/20 <br /> PRO540071 Daniel Gutierrez,BBP-CM 3/18/2020 <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 <br /> and client, date of procedure, instruments used, and written evidence from the manufacture that the instruments have <br /> undergone sterilization. The record of purchase, evidence of sterilization, type and number of instruments used shall be <br /> maintained for a minimum of 90 days after use. HSC 119315(f) Sterilization records were not available for lots in use <br /> in the facility. Submit a photograph of two lots in use in the facility along with matching sterilization certificates <br /> to the EHD by 12/1712019. <br /> All evidence of correction is due to the EH b 12/17/2019. <br /> L <br /> Failure to provide evidence of correction to the EHD by ill result in a re-inspection charged at the department's <br /> hourly rate of$152 per hour. All evidence of correction can be submitted to the department by email at jeaster(Qsjgov.org <br /> Notes: <br /> 1. Client records have lot numbers from the equipment used during the procedure. Most records are complete. A <br /> few lacked a description of the procedure, and one was missing a copy of the license. Assure that all records <br /> are completed at the time of the procedure. <br /> 2. The facility no longer uses an autoclave. All equipment is purchased as single use. <br /> 3. The IPCP was available for review. Consent Form, medical Questionnaire, and After Care have the required <br /> information. <br /> 4. Evidence of a recent sharps disposal on 10/23/2019 was available for review from Barnett Medical Services. <br /> 5. Permits and bloodborne pathogens training certificates are in a book on the front counter. <br /> Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Page 2 of 2 <br /> EH-11/17 <br />