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��° Body Art Inspe�n Report date: 324/1 <br /> 7 0 <br /> i San Joaquin County nvironmental Health Department <br /> Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: <br /> i <br /> (209)468-3420 <br /> ca i"%•''•`• +`P uhtrov.s o v_or /eh_,; Program Yl <br /> Element: <br /> COP <br /> PR Number PRACTITIONER/ARTIST NAME Number PRACTITIONER/ARTIST NAME <br /> PR0542669 Romaldo Rodriguez:BBP posted <br /> PRO542035 Blanca Rodriguez:BBP and 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) <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 /> RE.COVED <br /> ApR 12 2018 <br /> ENV ERf M1TESER CNTAL �TH <br /> Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Page 2 of <br /> EH-11/17 <br />