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Body Art InspeA. Report Date: 311,118 <br /> IH San Joaquin County Environmental Health Department Program <br /> ` 1 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: <br /> (209)468-3420 Program ,I 9�� <br /> �gc,FQRa www.sioov.org/ehd Element: `I(yV <br /> 01�' aggl <br /> PR0537649 Americo Salazar Jr. <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) <br /> 16. Client shall be at least 18 years of age to receive a tattoo, permanent cosmetics, or branding. Body piercing, unless <br /> performed in the presence of parent or guardian, the client, must be 18 years of age. HSC 119302- Provide copy of driver's <br /> license/identification with client records. <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- Include lot number with consent form. For medical questionnaire include: history <br /> of herpes infection at the procedure site, history of hemophilia or other bleeding disorders, history of cardiac valve <br /> disease, and other risk factors for bloodborne pathogens. <br /> 19. At the completion of the procedure, the practitioner shall provide postprocedure instr <br /> uctions that include all elements listed in Form B. HSC 119308(b)- Include signs and symptoms of infection as well as <br /> indications when to seek medical care. <br /> 34. Certificate of registration and health permit shall be posted in a conspicuous place. HSC 119306 and 119312 <br /> 35. Operation and employee training records shall be maintained for 3 years and made available for inspection. A written <br /> Infection Prevention and Control Plan (IPCP) shall be maintained, followed and updated. HSC 119313 <br /> Notes: <br /> 1) Post permit in a conspicuous place. <br /> 2) Maintain a copy of the IPCP on site. <br /> 3) Bloodborne pathogen training certification expires March 23, 2018. Maintain current bloodborne <br /> pathogen training certificate. <br /> Unless otherwise noted, correct all violations by March 15, 2018. <br /> Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Page 2 of 2 <br /> EH-11/17 <br />