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°k Body Art Inspection Report Date: February 24,2025 <br /> r.. . <br /> �. t, .� �11 San Joaquin County Environmental Health Department Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: PRO544020 <br /> %' :'i (209)468-3420 Program <br /> `,d:e;�a,. �P� v .sioay.ora/ehd <br /> Element: 4120 <br /> R Number PRACTITIONERIARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> PR0542967 FDnq Van BBP Ex :3/21/25 PRO547765 Lizet Orozco(BBP Ex :6/12/2025 <br /> PR0547605 Charlene Saetern BBP Ex : 12/26/2025 PR0547598 Paola Ais uro(BBP Ex : 11/11/2025 <br /> PR0543781 Lia Van BBP Ex : 12/11/2025 <br /> Observations and Corrective Actions: <br /> 6.A facility that uses single use instruments shall maintain record of purchase, log of procedures, names of <br /> practitioner and client, date of procedure, instruments used, and written evidence from the manufacture that the <br /> instruments have undergone sterilization. The record of purchase, evidence of sterilization, type and number of <br /> instruments used shall be maintained for a minimum of 90 days after use. HSC 119315(f) <br /> OBSERVATIONS: <br /> A sterilization certificate was not available for the Mellie Microblading cartridges (lot number ME2361). <br /> CORRECTIVE ACTION: <br /> Provide EHD with sterilization certificates for the instrument mentioned above. <br /> 18.The facility's client consent form and medical questionnaire must include all of the information listed in FORM B, <br /> and are available for inspection. HSC(119303) <br /> OBSERVATIONS: <br /> 1. Some of the client consent forms were not being fully Completed by the clients. <br /> 2. On page 2 of the "Tattoo Consent Form" under paragraph 6, it is stated that'I agree that is it my responsibility to contact <br /> my technician if there are any signs and symptoms of infection'. <br /> CORRECTIVE ACTIONS: <br /> 1. Ensure that clients are thoroughly completing the client consent forms. <br /> 2. Correct the language on the client consent form to include "seek medical care' in regards to observing signs and <br /> symptoms of infections. <br /> 33. A body art facility shall comply with the following: HSC(119314) <br /> (b) (6)All counters, surfaces, and trays shall have a smooth, durable, and nonabsorbent finish. <br /> OBSERVATIONS: <br /> Two felt benches were found in the procedure area. Surface of the benches were made of absorbent materials. <br /> CORRECTIVE ACTIONS: <br /> Completely remove the benches for the procedure area so as to not have any absorbent materials within procedure area. <br /> Correct all violations and provide evidence of corrections to <br /> the EHD by March 111h 2025 <br /> Reinspection on/about: A reinspection fee of$172 per hour may be charged. Page 2 of 3 <br /> EH-12-4-23 <br />