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.T17T� <br />1 PR0544791 I Lorlie TY - BBP Current and Posted I <br />Observations and Corrective Actions: <br />I PR Number I PRACTITIONER/ARTIST NAME I <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) — Provide evidence of sterilization for the purchased blades with the lot <br />number ISO 9002 to the EHD. coriewon due by Octo�a f Ll, Loll <br />Notes: <br />1. Facility is ok to open. <br />2. Once practitioner receives the facility and practitioner permit, post the permit in a conspicuous place. <br />3. Maintain a copy of the client Driver's License with their client consent form. <br />4. Include the lot number and expiration date of the blade use on the clients with their client consent form. <br />5. Review the Infection Prevention and Control Plan annually. Sign and date the IPCP after reviewing it. <br />6. If there is a new body art practitioner working at the facility, review the IPCP with the practitioner. <br />Reinspecion on/about: A reinspection fee of $152 per hour may be charged. Page 2 of 2 <br />EH -11/17 <br />BodyIns <br />Art p ecti �eport <br />Date: <br />._c <br />San Joaquin County Environmental Health Department <br />1868 E. Hazelton Ave., Stockton, CA 95205 <br />Program <br />Record: <br />Pr. <br />FURc�` <br />(209)468-3420 <br />www.siogv.org/ehd <br />Program <br />I / <br />2-0 <br />Element: <br />V7 <br />.T17T� <br />1 PR0544791 I Lorlie TY - BBP Current and Posted I <br />Observations and Corrective Actions: <br />I PR Number I PRACTITIONER/ARTIST NAME I <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) — Provide evidence of sterilization for the purchased blades with the lot <br />number ISO 9002 to the EHD. coriewon due by Octo�a f Ll, Loll <br />Notes: <br />1. Facility is ok to open. <br />2. Once practitioner receives the facility and practitioner permit, post the permit in a conspicuous place. <br />3. Maintain a copy of the client Driver's License with their client consent form. <br />4. Include the lot number and expiration date of the blade use on the clients with their client consent form. <br />5. Review the Infection Prevention and Control Plan annually. Sign and date the IPCP after reviewing it. <br />6. If there is a new body art practitioner working at the facility, review the IPCP with the practitioner. <br />Reinspecion on/about: A reinspection fee of $152 per hour may be charged. Page 2 of 2 <br />EH -11/17 <br />