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h 7 <br /> a°P°U'" Body Art Inspect Report Date: <br /> N San Joaquin County Environmental Health Department Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: <br /> _p (209)468-3420 Program <br /> �k FnR`' www.siogv.org/ehd 126 <br /> Element: <br /> PR Number PRACTITIONERIARTIST NAME PR Number PRACTITIONERIARTIST NAME <br /> Tanisha Green <br /> Observations and Corrective Actions: <br /> 6. A facility that uses single use instruments shall maintain record of purchase, log of procedures, names of <br /> practitioner and client, date of procedure, instruments used, and written evidence from the manufacture that the <br /> instruments have undergone sterilization. The record of purchase, evidence of sterilization, type and number of <br /> instruments used shall be maintained for a minimum of 90 days after use. HSC 119315(f) <br /> Provide sterilization certificates for the pre-sterilized equipment to be used in the facility. <br /> 7. The sharps waste container shall be within arm's reach and labeled with the word"sharps waste"or with the <br /> biohazard symbol and the word"Biohazard". Sharp waste containers shall be disposed by a licensed waste hauler <br /> or approved mail back system. Documentation of proper disposal shall be maintained for 3 years. HSC <br /> 119314(e) <br /> Provide properly labeled sharps container and a contract for sharps disposal. <br /> 11. The procedure area shall be equipped with a sink with hot and cold running water, containerized liquid soap, <br /> and single use paper towels dispensed from a wall-mounted, touchless dispenser that is readily accessible to <br /> practitioner- HSC 119314(b) <br /> Provide hand soap and a touchless paper towel dispenser. <br /> 18. The facilities client consent form and medical questionnaire must include all of the information listed in Form <br /> B, and are available for inspection. HSC 119303 <br /> Submit a copy of the client consent form and medical questionnaire to the EHD. <br /> 19. At the completion of the procedure, the practitioner shall provide post-procedure instructions that include all <br /> elements listed in Form B. HSC 119308(b) <br /> Submit a copy of the aftercare instructions to the EHD. <br /> 27. Products applied to skin prior to tattooing or application of permanent cosmetics, including, but not <br /> limited to,stencils, marking and transfer agents,shall be single use and discarded into a waste container <br /> at the end of the procedure. HSC 119311(a) <br /> Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Page 2 of 3 <br /> EH-11/17 <br />