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Body Art Inspece Report 71,g <br /> 2 °Z Date: Z <br /> a San Joaquin County Environmental Health Department Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: <br /> (209)468-3420 <br /> rq<,F �r.'� www.siogv.org/ehd Program <br /> Element: <br /> PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONERIARTIST NAME <br /> Lisa Marie Bates <br /> Jennifer De la santos <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) <br /> 13. Practitioner shall provide evidence of a completed, EHD approved, OSHA Bloodborne Pathogen Training consistent with <br /> section 119307. Certificate shall be posted on site. <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 /> 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 /> 36. Design plans shall be submitted to EHD for approval prior to constructing or remodeling body art facility. HSC 119312 <br /> Correct all violations noted above prior to final consultation. <br /> Notes: 1.) Prior to final consultation: <br /> -Correct all items listed above. <br /> -Contact EHD for final consultation inspection. <br /> Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Page 2 of 2 <br /> EH-11/17 <br />