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Body Art Ins elkn Report <br /> o Y p P Date:1. <br /> San Joaquin County Environmental Health Department Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 ✓7 Record: ��U�y <br /> (209)468-3420 r <br /> Program <br /> www.sioay.org/ehd Element: W 2,C7 <br /> PR Number PRACTITIONERtARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> Alanna Chao-1313P posted,permit not posted <br /> Carol Chao-1313P posted,permit not 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- Include a copy of driver's <br /> license/identification in client 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 history of cardiac valve disease,current medications, and other risk factor <br /> for bloodborne pathogens in medical questionnaire. <br /> 34. Certificate of registration and health permit shall be posted in a conspicuous place. HSC 119306 and 119312 <br /> Notes: <br /> 1) Post current permit in a conspicuous place. <br /> 2) Bloodborne pathogen training certification expires March of this year. Be sure to keen <br /> bloodborne pathogen training certification current. <br /> Unless otherwise noted, correct all violations by February 8th, 2018. <br /> l� <br /> Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Page 2 of <br /> EH-11/17 <br />