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Observations and Corrective Actions: <br />October 28. 2021 <br />New PR# <br />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 have a copy of their photo ID and the instrument lot <br />#'s were not written or attached to the records. Ensure client records have a copy of the clients ID and instrument lot <br />#s are either written or attached to the form. <br />Facility may now open. <br />Notes: <br />1. Inspection report emailed to owner, Jenna Spadafore, at jenna.spadafore(a)-gmail.com. <br />2. Post operating permit in conspicuous place when received. <br />3. Jenna will not use the BioMaser needles with lot # E0020893 until she receives the sterilization certificate. <br />4. Sharps Assure will be used for the shaps waste mail back system. <br />Reinspection on/about: A reinspection fee of $152 per hour may be charged. Page 2 of 2 <br />EH -11/17 <br />Body Art Inspection Report <br />Nz <br />San Joaquin County Environmental Health Department <br />Date: <br />Program <br />1868 E. Hazelton Ave., Stockton, CA 95205 <br />Record: <br />(209)468-3420 <br />c �Q <br />�4rFoc� <br />www.siogv.oM/ehd <br />Program <br />Element: <br />Observations and Corrective Actions: <br />October 28. 2021 <br />New PR# <br />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 have a copy of their photo ID and the instrument lot <br />#'s were not written or attached to the records. Ensure client records have a copy of the clients ID and instrument lot <br />#s are either written or attached to the form. <br />Facility may now open. <br />Notes: <br />1. Inspection report emailed to owner, Jenna Spadafore, at jenna.spadafore(a)-gmail.com. <br />2. Post operating permit in conspicuous place when received. <br />3. Jenna will not use the BioMaser needles with lot # E0020893 until she receives the sterilization certificate. <br />4. Sharps Assure will be used for the shaps waste mail back system. <br />Reinspection on/about: A reinspection fee of $152 per hour may be charged. Page 2 of 2 <br />EH -11/17 <br />