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EHD Program Facility Records by Street Name
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4100 – Safe Body Art
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PR0542562
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COMPLIANCE INFO
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Last modified
3/5/2025 9:13:07 AM
Creation date
7/3/2020 10:14:05 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4100 – Safe Body Art
File Section
COMPLIANCE INFO
RECORD_ID
PR0542562
PE
4120 - BODY ART FACILITY-SINGLE USE
FACILITY_ID
FA0021479
FACILITY_NAME
FLYING CROW TATTOO (EDWARDS,SHAWN)
STREET_NUMBER
245
Direction
W
STREET_NAME
YOSEMITE
STREET_TYPE
AVE
City
MANTECA
Zip
95336
APN
23505611
CURRENT_STATUS
Active, billable
SITE_LOCATION
245 W YOSEMITE AVE
P_LOCATION
03
P_DISTRICT
005
QC Status
Approved
Scanner
SJGOV\cfield
Supplemental fields
FilePath
\MIGRATIONS\BA\BA_4120_PR0542562_245 W YOSEMITE_.tif
Site Address
245 W YOSEMITE AVE MANTECA 95336
Tags
EHD - Public
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Body Art Inspectl�Report Date: ` I <br /> io �o <br /> 2� San Joaquin County Environmental Health Department ProgramC <br /> 1868 E.Hazelton Ave_,Stockton,CA 95205 Record: 512 <br /> (209)4683420 <br /> \ rRpRe�` www.siogv.org/ehd Program <br /> Element: <br /> PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> PR0537375 Shawn Edwards,BBP EU 7/12/20 <br /> PR0543920 Clayton Haley, BBP EU 10/14/20 <br /> PRO543922 Zachary Smith, PERMIT EXPIRED <br /> Observations and Corrective Actions: <br /> 9. No food, drink, tobacco product, or personal effects are permitted in the procedure area. HSC 119309 <br /> Beverage containers were by the handwash sink,and a beverage container was on top of a cabinet in the procedure <br /> area. <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, touch less dispenser that is readily accessible to practitioner. HSC 119314(b) <br /> Re-supply paper towel dispenser in the men's bathroom. <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 /> Record the date on the client forms at the time of the procedure. <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 /> The IPCP was unavailable. A copy was provided from the department file. Submit evidence of training with the <br /> IPCP to the EHD by 11/1912019. <br /> 37. A body art facility shall not conduct business without a valid health permit. A person shall not perform body art without a valid <br /> registration and a permitted facility. A body art facility shall notify the LEA in writing within 30 days of resignation, termination of a <br /> practitioner. Anew hire or apprentice must be registered the EHD prior to performing body art at the facility. HSC 119312 & <br /> 119306 <br /> Zachary Smith's permit has expired. Mr. Smith cannot practice in the shop until he renews his permit. If Mr. Smith is <br /> found practicing in the shop the shop will be charged $152. <br /> 1� <br /> All corrections are due by 11d/2019. <br /> Photographic evidence of correction can be submitted to the department at: ieaster(a)sigov.org <br /> Notes: <br /> 1. The Medical Questionnaire and the aftercare instructions have the required information. <br /> 2. Sterilization records were available for review and matched to two lots in inventory. <br /> 3. The facility uses Stericycle for sharps pick-up. The last pick-up was 6/7/19. <br /> Reinspecion oniabout: A reinspection fee of$152 per hour may be charged. Page 2 of 2 <br /> EH-11/17 <br />
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