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opaulti e <br /> Body Art Inspection Report Date: June 22,2026 <br /> 1 San Joaquin County Environmental Health Department program <br /> v: 1 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: PR0547208 <br /> �`'• ;•' (209)468-3420 <br /> www.sioay.org/ehd <br /> Program <br /> ��FORa' Element: 4120 <br /> PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> PR0547209 Sarah Williams(BBP Exp.4/25/27 PR0547210 Faustino Cruz BBP Exp.4/16/27 <br /> Observations and Corrective Actions: <br /> 18. HSC 119303 -Client records approved and available-Consent form and questionnaire <br /> OBSERVATIONS: <br /> The consent form did not include all the information from Form B. <br /> CORRECTIVE ACTIONS: <br /> The facility's client consent form and medical questionnaire must include all of the information listed in Form B, and are available <br /> for inspection. Add "description of what the client should expect following the procedure"to the consent form and provide an <br /> updated copy to the EHD. <br /> Correct all violations and provide evidence of correction to the EHD <br /> by July 7, 2026. <br /> Notes: <br /> 1. Inspection report emailed to facility owner, Sarah Williams, at infusion.smp(a).gmail.com. <br /> 2. The Infection Prevention and Control Plan was recently updated. Facility owner is to provide a copy to the EHD. <br /> 3. Client photo IDs are kept on Faustino Cruz's cell phone and not attached to the client records. This is permitted by the EHD. <br /> 4. Sterilization certificates were verified for the Eros needle cartridges with the lot#22/04 and #22/05. <br /> 5. Facility owner is to contact EHD if the facility will begin using a digital platform for client records. <br /> Reinspection on/about: A reinspection fee of$179 per hour may be charged. Page 2 of 2 <br /> EH-7-1-25 <br />