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" U1 <br /> " Body Art Inspeco Report is Date: Z AZA <br /> 2 San Joaquin County Environmental Health Department Program <br /> I { 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: <br /> (209)468-3420 <br /> www.siogv.org/ehd Program <br /> Element: <br /> PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> Thu Cindy Pham-BBP available <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) <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 /> 32. A body art facility shall have floors, walls, and ceilings that are smooth, nonabsorbent, free of open holes, and washable. <br /> The body art facility shall be free of insect and rodent infestation. The procedure area must be separated, by a wall, ceiling to <br /> floor, from nail and hair activities and be separated from all business not related to body art. Approval of co-located body art <br /> facilites are at the discretion of the LEA. A procedure area must be equipped with adequate light to perform a procedure. Each <br /> procedure area shall have lined waste containers. HSC 119314& 119317 <br /> 33. All surfaces and objects in the procedure area, including chairs, armrests, tables, countertops, and trays, shall be in good <br /> repair and capable of being disinfected. All counter surfaces and service trays in the procedure area shall have a smooth, <br /> durable, and nonabsorbent finish. HSC 119314 <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 <br /> Unless otherwise noted, all violations must be corrected within 30 days. <br /> Notes: <br /> 1.) Facility has been cleared to open once practitioner and facility permit have been obtained and Infection Prevention <br /> Control Plan has been submitted to EHD. <br /> Reinspecion onlabout: A reinspection fee of$130 per hour may be charged. Page 2 of 2 <br /> EH-03/2015 <br />