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Pau'" Body Art Inspects Report Sldl <br /> ••. Date: � <br /> a <br /> San Joaquin County Environmental Health Department Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: Posuun) <br /> p. (209)468-3420 Program <br /> www.siogv.org/ehd 9 �``�� <br /> Element: <br /> PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> PR0537386 Daniel Bryant <br /> PRO522429 James Moral <br /> PRO541142 Allen Estlin <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)-Submit a purchase record and corresponding sterilization certificate within <br /> 30 days. If not received within 30 days,an automatic re-inspection will be conducted at a rate of$139 per hour. <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 /> 28. Sterilized instrument packs, equipment and jewelry shall be stored in a labeled container or cabinet that is protected from <br /> dust or moisture. Sterile instrument packs shall be evaluated before use; instrument packs shall be discarded or reprocessed if <br /> condition is compromised. HSC 119315 <br /> 33. All surfaces and objects in the procedure area, including chairs, armrests, tables, countertops, and trays, shall be in good <br /> repair and capable of being disinfected. All counter surfaces and service trays in the procedure area shall have a smooth, <br /> durable, and nonabsorbent finish. HSC 119314 <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 /> Unless Otherwise Noted, Corrective Action Due in 30 days. <br /> Reinspecion onlabout: A reinspection fee of$130 per hour may be charged. Page 2 of 2 <br /> EH-03/2015 <br />