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"'" Body Art Inspeon Report 49 <br />r A, San Joaquin County Environmental Health Department <br />1868 E. Hazelton Ave., Stockton, CA 95205 <br />(209) 468-3420 <br />c9i.'l�:nW' P www.sjogv.org/ehd <br />PR Number <br />PRACTITIONER/ARTIST NAME <br />PR0542669 <br />Romaldo Rodriguez: BBP posted <br />PRO542035 <br />Blanca Rodriguez: BBP and permit posted <br />Observations and Corrective Actions: <br />Date: 3/LY/ld' <br />Program <br />Record: _005-1/?b(p <br />Program <br />Element: y/ 2-0 <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 />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 -Revise in medical questionnaire: other risk factors for bloodborne pathogens. <br />Notes: <br />1) Facility is cleared for operation. <br />2) Facility is using sharps mail -back system with Complete Needle Collection. <br />3) Upon receipt of facility permit, post in a conspicuous place. <br />4) Upon receipt, post pracititioner permit. <br />5) Update IPCP with sharps disposal information, and provide a copy to EHD. <br />Unless otherwise noted, correct all violations above by April 25, 2018. <br />Reinspecion on/about: A reinspection fee of $152 per hour may be charged. Page 2 of <br />EH -11/17 <br />