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Body Art Inspect Report 0 Date: r7 i/] el Z San Joaquin County Environmental Health Department Program ra z� 9 1868 E.Hazelton Ave.,Stockton,CA 95205 A%" 00 1-�G 3 (209)468-3420 Record: ! g V. wwwsjoqv.org/ehd orgiend Program U 0 3 4 F oe. Element: PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME PR0537641 Victor Hernandez Samuel Sandoval 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) 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 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 34. Certificate of registration and health permit shall be posted in a conspicuous place. HSC 119306 and 119312 35. Operation and employee training records shall be maintained for 3 years and made available for inspection. A written Infection Prevention and Control Plan (IPCP) shall be maintained, followed and updated. HSC 119313 Shop is allowed to begin operation. Have all of the above mentioned observations corrected prior to the routine inspection later this year. Reinspecion on/about: A reinspection fee of$130 per hour may be charged. Page 2 of 2 EH-03/2015