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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 />www.siogv.ora/ehd <br />PR Number <br />PRACTITIONER/ARTIST NAME <br />PR0547067 <br />Mary Nguyen BBP Ex 7/6/23 <br />Observations and Corrective Actions: <br />Date: August 16, 2022 <br />Program <br />Record: PR0547890 <br />Program <br />Element: 4120 <br />PR Number PRACTITIONER/ARTIST NAME <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 — Practitioner is utilizing Jot Form for client records. The client photo IN and lot <br />number of the needles were not included on the electronic format. Ensure the clients photo ID and the lot numbers of <br />the needles are included on the client consent form from now on. <br />Notes: <br />1. Inspection report emailed to Alaa Abdallah at abdallamalaa c(D.gmail.com and to Mary Nguyen at marybeautyink(c�Qmail.com. <br />2. Jot Form is used to store client records electronically. Practitioner will take a picture of the client's ID and the lot number of the <br />needle(s) used on client, per practitioner. <br />3. Sharps Compliance is utilized for sharps waste. Ensure sharps waste is disposed at least once a year. <br />4. Ensure permits are posted in a conspicuous place. <br />Reinspection on/about: A reinspection fee of $156 per hour may be charged. Page 2 of 2 <br />EH -11/17 _ <br />