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o r u ry <br /> o� Body Art Inspection Report Date: August 1 , 2022 <br /> LO 14 San Joaquin County Environmental Health Department Program <br /> 1868 E . Hazelton Ave. , Stockton , CA 95205 Record : PR0541676 <br /> (209) 4.68-3420 <br /> • C` �P • www. sogv.ora/ehd Program <br /> Element: 4120 <br /> PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> PR0547853 Cynthia Vasquez BBP Exp . 6/30/23 <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) — A sterilization certificate was not available for the Bowler blades with the <br /> lot number BE04012019 . Provide a sterilization certificate for the blade mentioned to the EHD . <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 — The medical questionnaire did not include all of the information listed in Form B . <br /> Include the following information and submit an updated copy the EHD : <br /> - History of herpes infection at the procedure site . <br /> - History of hemophilia or other bleeding disorders . <br /> - Requirements for antibiotics prior to surgery or dental procedures . <br /> = Other risk factors for bloodborne pathogens . <br /> Correct all violation and provide evidence of corrections to the EHD <br /> by August 14 , 2022 . <br /> Notes : <br /> 1 . The inspection report was emailed to facility owner, Cynthia Vasquez , at blushandbladestudio ccDgmail . com . <br /> 2 . Sharps Compliance INC will be used for sharps waste disposal . <br /> 3 . Ensure a copy of the client' s photo ID is attached to the records . <br /> 4 . Post health permit in a conspicuous place after it is received . <br /> Reinspection on /about: A reinspection fee of $ 156 per hour may be charged . Page 2 of 2 <br /> EH- 11 /17 <br />