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Body Art Inspecion Report z LZ <br /> Date: / 1I y <br /> San Joaquin County Environmental Health Department ram <br /> Pro <br /> ¢ . g <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: q S y <br /> (209)468-3420 <br /> c�i;r wy—siogv.org/ehd Program <br /> Element: 1112-0 <br /> PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> PRO541951 Taylor Mulroone :BBP and permit posted <br /> PRO542509 Raechel Morgan:BBP and permit posted <br /> PRO542386 Trang Truon -Tran:BBP and 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 consent form: notice that inks are not FDA approved and health <br /> consequences are unknown. Include in medical questionnaire: *history of herpes infection at the procedure site, <br /> history of allergic reactions to latex, history of allergic reactions to antibiotics, *history of cardiac valve disease, <br /> *requirements for antibiotics prior to surgery or dental procedures,and*other risk factors for bloodborne pathogens. <br /> 35. Operation and employee training records shall be maintained for 3 years and made available for inspection. A written <br /> Infection Prevention and Control Plan (IPCP) shall be maintained, followed and updated. HSC 119313-Maintain updated copy <br /> of IPCP on site. <br /> Notes: <br /> 1) Maintain updated IPCP on site. <br /> Unless otherwise noted, correct all violations by March 8, 2018. <br /> Reinspecion onlabout: A reinspection fee of$152 per hour may be charged. Page 2 of <br /> EH-11/17 <br />