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' Body Art Inspect Report 40 Date: _{I��i� <br /> San Joaquin County Environmental Health Department Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: f e'a <br /> (209)468-3420 <br /> \ �i_�6R`'`P• www_sioclv.org/ehd Program UhZu <br /> Element: �'1 <br /> PR Number PRACTITIONERIARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> PRO530665 Eddy Reyes <br /> PRO537907 Eddy Reyes Jr. <br /> PRO537476 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 /> 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 /> 19. At the completion of the procedure, the practitioner shall provide postprocedure instructions that include all elements listed in <br /> Form B. HSC 119308(b) <br /> Unless Otherwise Noted, Corrective Action Due in 30 days. <br /> Reinspecion onlabout: A reinspection fee of$130 per hour may be charged. Page 2 of 2 <br /> EH-03/2015 <br />