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Body Art InspectilbReport is Date: Z / I / I <br /> San Joaquin County Environmental Health Department Program Q/� <br /> µ 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: PRO Sit 140$ <br /> (209)468-3420 <br /> www.siogv org/ehd Program / I L0 <br /> Element: `�[ <br /> PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> Kymberleigh Thompson-BBP Updated and Posted <br /> PRO541907 and Expired Permit Posted <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)—Maintain proof of purchase and sterilization certificate for the blades on <br /> the facility at all time. <br /> 16. Client shall be at least 18 years of age to receive a tattoo, permanent cosmetics, or branding. Body piercing, unless <br /> performed in the presence of parent or guardian, the client, must be 18 years of age. HSC 119302—Provide a copy of the <br /> client's ID with their consent form. <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—Include the following statement in the medical questionnaire: history of <br /> hemophilia or other bleeding disorders and other risk factors for blood borne pathogen. <br /> Include the lot number of the blade uses on the client with the consent form. <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—Maintain a copy of <br /> IPCP on site and provide the EHD a copy of it. <br /> Note: <br /> 1. If you have any question, please contact me at(209)468-3284 or mvue@sjcehd.com <br /> 2. Provide a copy of the IPCP to the EHD. <br /> 3. Include all the missing information onto the medical questionnaire and provide a copy to the EHD. <br /> 4. Provide proof of sterilization for the blades to the EHD. <br /> Unless otherwise noted, correct all violations prior to February 15, 2019. <br /> Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Page 2 of 2 <br /> EH-11/17 <br />