COMPLIANCE INFO_NGUYEN, LIEU THI

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} + - Body Art InspectO Report Date: SIS Ir) San Joaquin County Environmental Health Department Program 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: P 1��7 ItLA p% (209)468-3420 Program VV / www.Siogv.org/ehd 1l _ Element: L PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME PRO537098 Lieu Thi Nguyen Observations and Corrective Actions: 6. A facility that uses single use instruments shall maintain record of purchase, log of procedures, names of practitioner and client, date of procedure, instruments used, and written evidence from the manufacture that the instruments have undergone sterilization. The record of purchase, evidence of sterilization, type and number of instruments used shall be maintained for a minimum of 90 days after use. HSC 119315(f)-Repeat violation 18. The facilities client consent form and medical questionnaire must include all of the information listed in Form B, and are available for inspection. HSC 119303-Forms are not completely completed. Have the forms completely completed and available for review during the next routine inspection. 28. Sterilized instrument packs, equipment and jewelry shall be stored in a labeled container or cabinet that is protected from dust or moisture. Sterile instrument packs shall be evaluated before use; instrument packs shall be discarded or reprocessed if condition is compromised. HSC 119315-Corrected on site. 33. All surfaces and objects in the procedure area, including chairs, armrests,tables, countertops, and trays, shall be in good repair and capable of being disinfected. All counter surfaces and service trays in the procedure area shall have a smooth, durable, and nonabsorbent finish. HSC 119314-Submit photographic evidence of compliance within 30 days. Unless Otherwise Noted, Corrective Action Due in 30 days. Reinspecion on/about: A reinspection fee of$130 per hour may be charged. Page 2 of 2 EH-03/2015