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1` <br /> Body Art Inspect9n Report • Date: L td <br /> San Joaquin County Environmental Health Department Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: <br /> (209)468-3420 Program <br /> tt; www.siogv.org/ehd Element: <br /> pending Tanisha Green <br /> Observations and Corrective Actions: <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 /> Medical Questionnaire: Prior to opening, change "take medication before dental work"to"Do you require <br /> antibiotics prior to surgery or dental work?" Submit a revised copy to the EHD by 2/11/2020. <br /> Okay to open. <br /> Notes: <br /> 1. Reminder: 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 at the <br /> end of the procedure. HSC 119311(a) <br /> 2. Post facility permit, artist permit, and bloodborne pathogens training permit once received. <br /> 3. The facility has one permited artist. <br /> Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Page 2 of 2 <br /> EH-11/17 <br />