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Body Art Inspec� Report A <br /> �.' a.. Date: <br /> r:. y <br /> San Joaquin County Environmental Health Department Program q <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: <br /> (209)468-3420 <br /> • cdtiFORc`P www.sio4v.or4/ehd Program �'� <br /> Element: <br /> PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONERJARTIST NAME <br /> PR0537385 Shane Winans <br /> PR0537527 Paul Marquez-No BBP or permit posted <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 copy of a purchase record and sterilization certificate and picture <br /> of the strip on the consent form. Ensure all three documents has a corresponding code(item or lot number). <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-Description of tattoo or piercing not indicated. <br /> 34. Certificate of registration and health permit shall be posted in a conspicuous place. HSC 119306 and 119312 <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-Annual training not <br /> documented. Submit a document with signatures indicating that the IPCP was covered. <br /> Notes: 1. Shane Winans BBP certificate has recently expired (2/2016). Shane was instructed to immediately complete <br /> another course of BBP training and submit the certificate. <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 />