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4. Body Art Inspe on Report Date: Wo//8 <br /> San Joaquin County Environmental Health Department Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 <br /> (209)46E-3420 Record: Ustfr&po <br /> Program <br /> a'daa`° www.sioov.om/ehd 4/?� <br /> Element: <br /> PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> PR0541479 Chelsea Ramse -BBP posted,permit posted <br /> Observations and Corrective Actions: <br /> 16. Client shall be at least 18 years of age to receive a tattoo, permanent cosmetics, or branding. Body piercing, unless <br /> performed in the presence of parent or guardian, the client, must be 18 years of age. HSC 119302-Provide copy of driver's <br /> license/identification with client records. <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-Include in medical questionnaire: other risk factors for bloodborne pathogens. <br /> Unless otherwise noted, correct all violations by March 4, 2018. <br /> Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Page 2 of <br /> EH-11/17 <br />