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Body Art Inspect* Report 40 Date: M-9 <br /> �ZQ�� <br /> San Joaquin County Environmental Health Department Program <br /> l 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: <br /> (209)468-3420 <br /> Program <br /> _tp-0' ' www.sioqv.org/ehd <br /> Element: <br /> PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> PRO542034 Megan Errecalde <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) <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 /> 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 /> Correct all violations noted above by July 27, 2017. <br /> Notes: <br /> 1. Facility has been approved to open. <br /> 2. Post Bloodborne pathogen certificate, facility permit, and practitioner registration. <br /> 3. IPCP has been completed. Submit IPCP to EHD. <br /> 4. If additional rooms will be used for body art, a consultation inspection will be required to approve additional rooms for <br /> use. Only 1 room is approved at this time. <br /> Reinspecion on/about: A reinspection fee of$130 per hour may be charged. Page 2 of 2 <br /> EH-03/2015 <br />