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L! 17777 = =• # <br />NW -11% MFIIMITMITM��, 4 W*j"lZi <br />USAMT01:i <br />FO. <br />Date: W 4is <br />Program <br />Body Art Inspean Report <br />Record: <br />San Joaquin County Environmental Health Department <br />Program <br />1868 E. Hazelton Ave., Stoddon, CA 95205 <br />Element: <br />(209) 468-3420 <br />MnyApgv orq/ehd <br />L! 17777 = =• # <br />NW -11% MFIIMITMITM��, 4 W*j"lZi <br />USAMT01:i <br />FO. <br />Date: W 4is <br />Program <br />PRACTITIONERIARTIST NAME <br />Record: <br />f'cjSiA 00 <br />Program <br />William,Edgin <br />Element: <br />1"o <br />L! 17777 = =• # <br />NW -11% MFIIMITMITM��, 4 W*j"lZi <br />USAMT01:i <br />FO. <br />Date: W 4is <br />Program <br />Record: <br />f'cjSiA 00 <br />Program <br />Element: <br />1"o <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. HSC119314(b)-a <br />site visit wi ' If be,pv)rformed later to verify that hot water Is running. <br />18. The facilities client consent form and medical questionnaire must include at1l of tihe info m ation listed in Form 13, and are <br />2vailable for inspection. HSC 119303 <br />19. Al, <br />fl%L the completion of tut le procedure, the practitioner shall provide postprocedure instructions that include all elem tents listed in <br />Form B. HSC 119308(b) <br />2_15. Any part of a taltoolng maw 13710 that may touch the practitioner during procedure shlall be cv,/ereud wl'th a disposable plastic <br />sheat th. HSC 1191311(h;- corrected on site. <br />iN <br />lie <br />oikw <br />n! ph�n �!Or'p! Sh=!! <br />Infection Prevent -ion and f-ontr,'. . <br />a coma Fsm�%­m­ an= a mm�m. %Am.m W <br />