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Body Art Inspect ReportDate: A of 7 <br /> ' x� San Joaquin County Environmental Health Department Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: <br /> (209)468-3420 <br /> .c .........fie: Program <br /> I <br /> t,FORN www.siogv.oro/ehd <br /> Element: <br /> PR Number PRACTITIONERIARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> Heidi Johnson <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)—Ensure sterilization certificate is obtained for all future purchases. <br /> 11. The procedure area shall be equipped with a sink with hot and cold running water, long handles(no knobs), containerized <br /> liquid soap, and single use paper towels dispensed from a wall-mounted, touchless dispenser that is readily accessible to <br /> practitioner. HSC 119314(b) <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 prior to final <br /> inspection. <br /> Notes: <br /> 1.) Prior to opening, facilitly will need to: <br /> a. Correct all violations. <br /> b. Pass final inspection. <br /> 2.) Contact EHD once you are ready for the final inspection. <br /> 3.) Display bloodborne pathogen certificate. <br /> Reinspecion oniabout: A reinspection fee of$130 per hour may be charged. Page 2 of 2 <br /> EH-03/2015 <br />