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i;. <br /> Body Art InspecI Report Date: / <br /> San Joaquin County Environmental Health Department Program l.-� �1 <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: 1 12 <br /> F. (209)468-3420 <br /> c°<�F0- www.siogv.org/ehd Program Element: _1�gc)S2L4 I -f <br /> PR Number PRACTITIONERIARTIST NAME PR Number PRACTITIONERIARTIST NAME <br /> PRO541639 Kristen Patterson-Cranford <br /> PR0541640 Gayle Witt <br /> Observations and Corrective Actions: <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 sterilization certificate for needles(lot number: 018091233). <br /> Note: <br /> 1. Facility is ok to open. <br /> Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Page 2 of 2 <br /> EH-11/17 <br />