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"�" Body Art Inspece Report Date: <br /> )� Cp <br /> y` San Joaquin County Environmental Health Department Program p /� <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: 6 ()S 7 Li 2y <br /> (209)468-3420 <br /> a`P a www.sioov.oroiehd Program <br /> Element: <br /> PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> PR0539116 Esau Mendoza-no BBP,Permit posted PR0540006 Jessie Witt-no BBP,holding permit <br /> PR0537423 Chris McPherson-no BBP,holding permit PR0537993 Ruben Benites-permit posted,no BBP <br /> PR0538823 Erick Jimenez-no BBP,permit posted PRO540023 Erik Oliveras-BBP posted,provided permit to facili <br /> -71 <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 /> 13. Practitioner shall provide evidence of a completed, EHD approved, OSHA Bloodborne Pathogen Training consistent with <br /> section 119307. <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 /> 19. At the completion of the procedure, the practitioner shall provide postprocedure instructions that include all elements listed in <br /> Form B. HSC 119308(b) <br /> 36. Design plans shall be submitted to EHD for approval prior to constructing or remodeling body art facility. HSC 119312 <br /> Notes: <br /> 1.) Facility must have another handwash sink installed prior to next routine inspection. <br /> Violations noted above will be checked during the next <br /> routine. Failure to comply will result in an automatic <br /> re-inspection. <br /> Reinspecion on/about: A reinspection fee of$130 per hour may be charged. Page 2 of 2 <br /> EH-03/2015 <br />