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Body ec* Report <br /> p P Date: <br /> Y Art Ins <br /> San Joaquin County Environmental Health Department Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: b6 <br /> `p (209)468-3420 <br /> c Program <br /> <�FORp www.slogv.org/ehd <br /> Element: 4 F b 3 <br /> PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONERIARTIST NAME <br /> Thu Cindy Pham <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 /> 7. The sharps waste container shall be within arm's reach and labeled with the word ''sharps waste"or with the biohazard symbol <br /> and the word "Biohazard". Sharp waste containers shall be disposed by a licensed waste hauler or approved mail back system. <br /> Documentation of proper disposal shall be maintained for 3 years. HSC 119314(e) <br /> 11. The procedure area shall be equipped with a sink with hot and cold running water, containerized liquid soap, and single use <br /> paper towels dispensed from a wall-mounted, touchless dispenser that is readily accessible to practitioner. HSC 119314(b) <br /> 13. Practitioner shall provide evidence of a completed, EHD approved, OSHA Bloodborne Pathogen Training consistent with <br /> section 119307. <br /> 14. Practitioner shall put on appropriate personal protective equipment, including gloves, aprons, lap pads, etc. Gloves shall be <br /> worn throughout the procedure. HSC 119308(a) <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 /> 1. Rus%z{=flines i.seri durino a -mcedure shall be decontaminated upon completion of the procedure. The practitioner must wash <br /> and disinfect the reusable instruments using disposable gloves. HSC 119311(h) <br /> 111 �.:_:_ t,_ . ,_-. _�-.,....,_ F•-- "-----�--- -_ `;- -. . -- <br /> 44. DISH ilactai iC S1 icdli i 1dVC c7.i.�iuty tai i cuii%ir iii viii iiia idiC U ii; P1�JGi k,C iU1 UiSaaS�-i.dubil it9 i 1 m.;i iUU1 ydi iiSi i i5, ii-liaUUii iy iii V di iu <br /> hepatitis B virus. HSC -1-1930-1(k) <br /> <.. +.-•.....-.... ... . .I[J.. u. --cu '300ormi il,. to Li is B i a tui WtuM, J instructions. 116C 1 I JVL/Jit%/ <br /> 26. Any part of a tattooing machine that may touch the practitioner during procedure shall be covered with a disposable plastic <br /> cheath. HSr 11q'411(h) <br /> Reinspecion on/about: A reinspection fee of$130 ner hour may be charged. Paae 2 of 3 <br />