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Body Art Inspecti4pReport 10 Date: 1 A <br /> San Joaquin County Environmental Health Department Program 7 2 <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: �t12-d`CC 3 7 134 <br /> .., (209)468-3420 Program t , <br /> \q<<FORzi` wwva.siogv.orq/ehd Element: —1 I�1 <br /> PR Number PRACTITIONERIARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> PRO537131 Victor Lara <br /> Observations and Corrective Actions: <br /> 1. Each sterilization load shall be monitored with mechanical indicators for time, temperature and pressure, Sterilization shall be <br /> accomplished by steam autoclave, manufactured for the sterilization of medical instruments, and pass a Class V integrator test. <br /> HSC 119315(b) <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 /> 11. The procedure area shall be equipped with a sink with hot and cold running water, containerized liquid soap, and single use <br /> paper towels dispensed from a wall-mounted, touchless dispenser that is readily accessible to practitioner. HSC 119314(b) <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 /> Unless otherwise noted, Corrective Action Due in 30 days. <br /> Reinspecion on/about: A reinspection fee of$130 per hour may be charged. Page 2 of 2 <br /> EH-03/2015 <br />