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0"!"' C, <br />Body Art <br />Inspecla Report <br />Date: <br />` <br />;. <br />San Joaquin County Environmental Health Department <br />1868 E. Hazelton Ave., Stockton, CA 95205 <br />Program <br />Record: <br />o sem;: P <br />(209) 468-3420 <br />www.soogv.org/ehd <br />Program <br />g <br />Element: <br />PR Number PRACTITIONERIARTIST NAME <br />Kacey Price <br />Trevor Walsh <br />Justin Thomas <br />Irene Hernandiz <br />Observations and Corrective Actions: <br />I PR Number I PRACTITIONER/ARTIST NAME I <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 />19. At the completion of the procedure, the practitioner shall provide postprocedure instructions that include all elements listed in <br />Form B. HSC 119308(b) <br />32. A body art facility shall have floors, walls, and ceilings that are smooth, nonabsorbent, free of open holes, and washable. <br />The body art facility shall be free of insect and rodent infestation. The procedure area must be separated, by a wall, ceiling to <br />floor, from nail and hair activities and be separated from all business not related to body art. Approval of co -located body art <br />facilites are at the discretion of the LEA. A procedure area must be equipped with adequate light to perform a procedure. Each <br />procedure area shall have lined waste containers. HSC 119314 & 119317 <br />Notes: <br />1.) 4 practitioners for this facility came into EHD and registered today. <br />2.) Facility has been approved to open. <br />3.) Facility permit was paid today at EHD. <br />4.) Post facility permit, practitioner permits, and bloodborne pathogen training certificates. <br />Reinspecion on/about: A reinspection fee of $130 per hour may be charged. Page 2 of 2 <br />EH -03/2015 <br />