Laserfiche WebLink
eo Body Art Inspecti(Weport Date: Z/1 Z l q <br /> ? San Joaquin County Environmental Health Department Program pp US �� <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: f <br /> (209)468-3420 Program (� <br /> .\c'CiFORa`P www.sioay.org/ehd Element: — 1'ZO <br /> PR Number PRACTITIONERtARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> PRO541622 Erica Green-Frese <br /> Observations and Corrective Actions: <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—Add the statement"or other bleeding disorders"to hemophilia.Correct this prior <br /> to February 26, 2019. <br /> Note: <br /> 1. If you have any question, please contact me at(209)468-3284 or mvue@sjcehd.com <br /> 2. Send a copy of the updated medical questionnaire to the EHD. <br /> 3. Review the Infection Prevention and Control Plan once a year. <br /> 4. Make sure to leave the surfaces wet for a minimum of three minutes for adequate time to disinfect the surfaces. <br /> Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Page 2 of 2 <br /> EH-11/17 <br />