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PgU�p <br />Body Art Inspec* Report <br />'O "J <br />Aaron Brockman-BBP <br />S <br />San Joaquin County Environmental Health Department <br />PR0537718 <br />1868 E. Hazelton Ave., Stockton, CA 95205 <br />(209) 468-3420 <br />�•.-,`. <br />4�;••b. a`P <br />FR <br />www.siooy.org/ehd <br />PR Number <br />PRACTITIONER/ARTIST NAME <br />PR0537531 <br />Aaron Brockman-BBP <br />PR0537538 <br />Max Ackermann-BBP <br />PR0537718 <br />Thomas Shea <br />Observations and Corrective Actions: <br />PR Number <br />Date: 5/13115 <br />Program <br />Record: Oct) - <br />Program <br />Element: L4I Zy <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)-�nt�,�- Ishl IS, <br />7. The sharps waste container shall be within arm's reach and labeled with the word "sharps waste" or with the biohazard symbol <br />and the word "Biohazard. Sharp waste containers shall be disposed by a licensed waste hauler or approved mail back system. <br />Documentation of proper disposal shall be maintained for 3 years. HSC 119314(e)- CoJleukj (S/L2-)Ig <br />13. Practitioner shall provide evidence of a completed, EHD approved, OSHA Bloodborne Pathogen Training consistent with <br />section 119307. - (w f dee C S I1,L11 S) <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 _c0fro jAA(S1lL(t S) <br />19. At the completion of the procedure, toe practitioner shall provide postprocedure instructions that include all elements listed in <br />Form B. HSC 119308(b), cwfi,-�Q-A cslwlS) <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 eorfeJeok isl ulj <br />A site visit will be performed next week. All of the above <br />listed items must be corrected before the site visit. If <br />during the site visit, it is observed that there are remaining <br />issues, there will be a $130 charge. <br />Reinspecion onlabout: A reinspection fee of $130 per hour may be charged. Page 2 of 2 <br />EH -03/2015 <br />