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.0 Body Art Inspect* Report Date: <br /> ? San Joaquin County Environmental Health Department Program CIV7 <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: �" ✓ v �! <br /> c• (209)468-3420 Program G <br /> PI.- ' w` w.sio4v.orq/ehd <br /> Element: <br /> PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> PR0537407 Luna Shirley <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 /> 11. The procedure area shall be equipped with a sink with hot and cold running water, containerized liquid soap, and single use <br /> paper towels dispensed from a wall-mounted, touchless dispenser that is readily accessible to practitioner. HSC 119314(b) <br /> 13. Practitioner shall provide evidence of a completed, EHD approved, OSHA Bloodborne Pathogen Training consistent with <br /> section 119307. <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 /> 27. Products applied to skin prior to tattooing or application of permanent cosmetics, including, but not limited to, stencils, <br /> marking and transfer agents, shall be single use and discarded into a waste container at the end of the procedure. HSC <br /> 119311(a) <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 <br /> Reinspecion on/about: A reinspection fee of$130 per hour may be charged. Page 2 of 2 <br /> EH-03/2015 <br />