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Body Art Inspecis Report Date: <br /> �o A t ro <br /> `z San Joaquin County Environmental Health Department Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: PRO �s <br /> (209)468-3420 <br /> r4cr rine'c• www.sjogv.org/ehd Program <br /> Element: Li 1 b <br /> PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> PR0537098 Lieu Thi Nguyen <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)-Have the purchase record and sterilization document available for the next <br /> routine inspection. <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 /> Notes: 1. Provide a copy of the sharps contract with Barnett.- GbivLrjej 91sh S <br /> 2. Provide a copy of the IPCP. �C;oSr��ctt� gj3li5 <br /> Unless otherwise noted, Corrective Action Due in 30 days. <br /> Reinspecion on/about: A reinspection fee of$130 per hour may be charged. Page 2 of 2 <br /> EH-03/2015 <br />