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Body Art Inspect Report San Joaquin County Environmental Health Department 1868 E. Hazelton Ave., Stockton, CA 95205 (209) 468-3420 Sd'.iFBRix�. www.sjogv.org/ehd PR Number PRACTITIONER/ARTIST NAME 538859 Alec M Peralta 538193 Angel Le 537416 Paulo Da Silva Observations and Corrective Actions: Date: Program Record: Program Element: 6'a -r cam_ LIIX(_ PR Number PRACTITIONERIARTIST NAME 538705 Daniel Zapata 537415 Michael Carter 537414 Phillip Vasquez 4. Sterilizer shall be spore -tested after initial installation, after major repair, and at least once per month. A written sterilization shall be maintained for 3 years. The log shall include spore -test results each sterilization cycle, date, contents, exposure time and temperature, results of the Class V integrator for every cycle/load, and evidence of a acceptable spore test before reuse of the sterilizer after a failed spore -test. HSC 119315(b) 5. Decontamination and sterilization areas shall be separated from procedure areas by a space of at least 5 feet or by a cleanable barrier and equipped with a sink with hot and cold running water, containerized liquid soap, and single use paper towels dispensed from a wall -mounted, touchless dispenser that is readily accessible to practitioner. HSC 119314(c) 6. A facility that uses single use instruments shall maintain record of purchase, log of procedures, names of practitioner and client, date of procedure, instruments used, and written evidence from the manufacture that the instruments have undergone sterilization. The record of purchase, evidence of sterilization, type and number of instruments used shall be maintained for a minimum of 90 days after use. HSC 119315(f) - Obtain the following documentation from Body Art Manufacturers: Written proof on company or laboratory letterhead showing th. the presterilized instruments have undergone a sterilization process. Written proof shall clearly identify the instruments sterilized b name or item number and shall identify the lot or batch number of the sterilizer run. 7. The sharps waste container shall be within arm's reach and labeled with the word "sharps waste" or with the biohazard symbol and the word "Biohazard". Sharp waste containers shall be disposed by a licensed waste hauler or approved mail back system. Documentation of proper disposal shall be maintained for 3 years. HSC 119314(e) 11. The procedure area shall be equipped with a sink with hot and cold running water, containerized liquid soap, and single use paper towels dispensed from a wall -mounted, touchless dispenser that is readily accessible to practitioner. HSC 119314(b) 13. Practitioner shall provide evidence of a completed, EHD approved, OSHA Bloodborne Pathogen Training consistent with section 119307. 18. The facilities client consent form and medical questionnaire must include all of the information listed in Form B, and are available for inspection. HSC 119303 - Include the following statement on consent forms: Tattoo inks, dyes and pigments have not been approved by the federal Food and Drug Administration and that the health consequences of using thses products are unkown. 19. At the completion of the procedure, the practitioner shall provide postprocedure instructions that include all elements listed in Form B. HSC 119308(b) Reinspecion on/about: A reinspection fee of $125 per hour may charged. Page 2 of 3 EH -04/2014