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1 <br /> tA <br /> `' y / <br /> Body Art InspeA Report Date: �31 15 <br /> 3 j San Joaquin County Environmental Health Department Program C <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: <br /> (209)468-3420 <br /> c°� Fc RN`P www.slogv.org/ehd Program <br /> Element: l� V <br /> PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> PR0530665 Eddy Reyes <br /> PR0538646 Billy Dias-no longer working here <br /> PRO537907 Eddy Reyes Jr. <br /> PR0537476 I Marcos Adame <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 /> 11. The procedure area shall be equipped with a sink with hot and cold running water, containerized liquid soap, and single use <br /> paper towels dispensed from a wall-mounted, touch less dispenser that is readily accessible to practitioner. HSC 119314(b) <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 <br /> 31. A body art facility shall be separated from any residential areas used for sleeping, bathing, or meal preparation and shall not <br /> share a common entrance or toilet facility with residence. The toilet facility must have a sink with hot and cold water, <br /> containerized liquid soap, and single-use paper towels that are dispensed from a wall-mounted, touchless dispenser. HSC <br /> 119314 <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: 1. The sink in the procedure area does not have running water. This issue must be corrected immediately. Submit <br /> evidence of compliance once the sink has running water. <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 />