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°".. Body Art Inspect Report Date: ` /-Z-7/IS <br /> San Joaquin County Environmental Health Department Program n �y <br /> 1, 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: Py <br /> o v`• (209)468-3420 Program <br /> www.siogv.org/ehd <br /> Element: �Z <br /> PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> PR0537521 Sonny J.Brown-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 client <br /> date of procedure, instruments used, and written evidence from the manufacture that the instruments have undergone sterilization. <br /> The record of purchase, evidence of sterilization, type and number of instruments used shall be maintained for a minimum of 90 do <br /> after use. HSC 119315(f) <br /> 13. Practitioner shall provide evidence of a completed, EHD approved, OSHA Bloodborne Pathogen Training consistent with secti <br /> 119307. <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, all violations must be corrected within 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 />