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Body Art InspecUeReport Date: <br /> r~ San Joaquin County Environmental Health Department ram <br /> Pro <br /> < 9 <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: <br /> (209)468 3420 <br /> s. Program <br /> t+F raRi1`' www.siogv.org/ehd 41, ':71o, <br /> Element: K/ <br /> PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> 536969 Shelley Kohl <br /> a <br /> Observations and Corrective Actions: <br /> 6. A facility that uses sinqle use instruments shall maintain record of written evidence from the manufacture that the instruments <br /> :...,u �.,,a,Eiraone sterilization. Written proof shall clearly identifv the instruments sterilized by name or itme number and shall <br /> identify the lot or batch number of the sterilizer run. The record of purchase, evidence of sterilization, type and number of <br /> instruments used shall be maintained for a minimum of 90 days after use. HSC 119315(f) <br /> 11. The procedure area shall be equipped with a sink with single use paper towels dispensed from a wall-mounted, toy--^hlo�n <br /> 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 /> 19. At the completion of the procedure, the practitioner shall provide postprocedure instructions that include all elements iisted in <br /> Form B. HSC 119308(b) <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 <br /> Unless otherwise noted, corrective Action is due within 30 days. <br /> Reinspecion on/about: A reinspection fee of$125 per hour may charged. Page 2 of 2 <br /> EH-04/2014 <br />