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COMPLIANCE INFO
Environmental Health - Public
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EHD Program Facility Records by Street Name
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4100 – Safe Body Art
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PR0541625
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COMPLIANCE INFO
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Last modified
3/31/2023 12:44:55 PM
Creation date
7/3/2020 10:13:57 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4100 – Safe Body Art
File Section
COMPLIANCE INFO
RECORD_ID
PR0541625
PE
4120
FACILITY_ID
FA0023858
FACILITY_NAME
NATHAN A KLUDT MD INC (JOHNSON, HEIDI)
STREET_NUMBER
1805
Direction
N
STREET_NAME
CALIFORNIA
STREET_TYPE
ST
City
STOCKTON
Zip
95204
CURRENT_STATUS
02
SITE_LOCATION
1805 N CALIFORNIA ST STE 407
P_LOCATION
01
QC Status
Approved
Scanner
SJGOV\cfield
Supplemental fields
FilePath
\MIGRATIONS\BA\BA_4120_PR0541625_1805 N CALIFORNIA_.tif
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EHD - Public
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Body Art Inspsion Report 40Date: 3!21/!8 <br /> San Joaquin County Environmental Health Department <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Program <br /> �• Record: l991 05,V1fs?.j� <br /> (209)468-3420 <br /> www.siogv.org/ehd Program L/'20 <br /> Element: <br /> PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> PRO541626 Heidi Johnson:BBP and 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(0-Contact manufacturer for record of sterilization, including lot number for <br /> future purchases. <br /> 27. Products applied to skin prior to tattooing or application of permanent cosmetics, including, but not limited to, stencils, <br /> marking and transfer agents, shall be single use and discarded into a waste container at the end of the procedure. HSC <br /> 119311(a) <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 /> Notes: <br /> 1) For future purchases,contact manufacturer for sterilization records. <br /> 2) Maintain updated copy of IPCP on site. <br /> Unless otherwise noted,correct all violations by April 4,2018. <br /> Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Page 2 of <br /> EH-11/17 <br />
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