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"Qui" ro Body Art Inspect& Report Date: <br /> G' <br /> San Joaquin County Environmental Health Department <br /> Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 P� SH I G <br /> \\� (209)468-3420 Program <br /> t1Fd'a�'` www.siogv.orq/ehd J <br /> Element: y 12- <br /> PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> Jennifer Spadafore-BBP and Permit Current and <br /> PRO541683 Posted <br /> Observations and Corrective Actions: <br /> 16. Client shall be at least 18 years of age to receive a tattoo, permanent cosmetics, or branding. Body piercing, unless <br /> performed in the presence of parent or guardian, the client, must be 18 years of age. HSC 119302—Maintain a copy of the <br /> cleints' Driver's License with their records. <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—Include the following statement to the medical questionnaire"Hemophilia or other <br /> bleeding disorders." <br /> Note: <br /> 1. Review the Infection Prevention and Control Plan annually. Sign and date the IPCP after reviewing it. <br /> Correct all violations prior to July 3, 2019. <br /> Reinspecion onlabout: A reinspection fee of$152 per hour may be charged. Page 2 of 2 <br /> EH-11/17 <br />