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Body Art Inspection Report <br />San Joaquin County Environmental Health Department <br />1868 E. Hazelton Ave., Stockton, CA 95205 <br />(209) 468-3420 <br />'c #- w .siow.ora/ehd <br />qG/FORD <br />PR Number <br />PRACTITIONER/ARTIST NAME <br />PR0547508 <br />Cassandre Uecker BBP exp. 10-1-22 <br />^ Page 2 <br />of 2 <br />EH -11/17 <br />Observations and Corrective Actions: <br />Date: March 2, 2022 <br />Program <br />Record: PR0547507 <br />Program <br />Element: 4120 <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 — The client records did not consist of the client's photo ID or the lot number of the <br />blade that was used. Ensure a copy of the client's photo ID is kept with the client's records and write or attach package <br />of blade to the consent form to indicate the lot number of the blade that was used. <br />Facility May Now Open <br />Notes: <br />1. Inspection report was emailed to facility owner, Cassandre Uecker, at cassiouinlivenCa vahoo.com. <br />2. Stericycle is the sharps waste hauler. Sharps waste is picked up every <br />3 to 4 months, per facility owner. <br />3. Ensure receipts/ manifests from sharps disposal is kept for a minimum of 3 years. <br />4. Cassandra Uecker will change blades from Chuse to Tina Davies. Proof of purchase of the Tina Davies blades was received <br />by the EHD. <br />5. Facility owner informed to have students/ trainees register with the EHD if live models are used for training. <br />6. All new practitioners and students are to be trained on the Infection Prevention and Control Plan. Training records are required <br />to be on site for review by the EHD. <br />Reinspection oNabout: <br />A reinspection fee <br />of $152 <br />per hour may be charged. <br />^ Page 2 <br />of 2 <br />EH -11/17 <br />/L/i[i/) <br />