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,c Body Art InspectioReport 0 q <br /> °c Date: ! �/ <br /> k San Joaquin County Environmental Health Department Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: (' <br /> to <br /> " (209)468-3420 <br /> www.siogv.org/ehd Program <br /> Element: Pe-0 S7Sa <br /> PR Number PRACTITIONERIARTIST NAME PR Number PRRCTITIONER/ARTIST NAME <br /> PR0515393 John Highland PR0537375 Shawn Edwards <br /> PRO541553 Leanna Martinez PR0539346 Kristal E Betancourt <br /> PR0541902 Jessica Orsua PR0537376 Ne htali Bru ueras <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 /> ^iinnt riata of nrorarii irp inctrumPnts i mpri anri written Pvidt-nre from the manufacture that the instruments have undergone <br /> sterntzaaon. i ne recora of purcnase, evidence of sterilization, type and number of instruments used shall be maintained for a <br /> minimum of 90 days after use. HSC 119315(f) If corrective action documentation is not received within 30 days,a re- <br /> inspection will be conducted at a rate of$152.00 per hour. <br /> 33. All surfaces and objects in the procedure area, including chairs, armrests, tables, countertops, and trays, shall be in good <br /> renair`nel f%;n We of being disinfected. AI!counter surfaces and service trays in the procedure area shall have a smooth. <br /> durable, and nonabsorbent finish. HSC 119314 <br /> 35. Operation and employee training records shall be maintained for 3 years and made available for inspection. P. :Rrif*r^ <br /> Infection Prevention and Control Plan (IPCP) shall be maintained, followed and updated. HSC 119313 <br /> Unless otherwise noted, Corrective Action Due in 30 days. <br /> Reinspecion on/about: A reinspection fee of$125 per hour may charged. Page 2 of 2 <br /> EH-04/2014 <br />