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4100 – Safe Body Art
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PR0543585
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COMPLIANCE INFO
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Entry Properties
Last modified
6/15/2023 2:46:00 PM
Creation date
7/3/2020 10:15:51 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4100 – Safe Body Art
File Section
COMPLIANCE INFO
RECORD_ID
PR0543585
PE
4121
FACILITY_ID
FA0021614
FACILITY_NAME
BLACK ROSE TATTOO PARLOR, THE (VASQUEZ, SAMUEL)
STREET_NUMBER
237
Direction
E
STREET_NAME
MINER
STREET_TYPE
AVE
City
STOCKTON
Zip
95202
CURRENT_STATUS
02
SITE_LOCATION
237 E MINER AVE
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
Scanner
SJGOV\cfield
Supplemental fields
FilePath
\MIGRATIONS\BA\BA_4121_PR0543585_237 E MINER_.tif
Tags
EHD - Public
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Body Art Inspec Report Date: 611,111 <br /> San Joaquin County Environmental Health Department Program a <br /> (209)468-3420 <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: Q 2 O�'S7313 <br /> � ) <br /> P, Program �1��' <br /> www.sjogv.orq/ehd <br /> ---- Element: <br /> PR Number PRACTITIONERIARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> PRO536973 Jose Zuni a PR0540259 Bra an Lares <br /> PR0541182 Jorge Perez PR0537490 Christopher Flores <br /> PR0537547 Samuel Vasquez <br /> PR0537653 Jesse Quezada <br /> Observations and Corrective Actions: <br /> All violations noted on the 5/17/17 inspection report have been corrected. <br /> Notes: 1. The medical questionnaire has all the required information. However it needs to be re-formatted to allow clients to <br /> indicate each condition individulally. <br /> 2. Facility is currently using Mithra for tattoo equipment. The purchase record and sterilization certificate do not have <br /> a matching identification number(item, lot, etc.). Mithra was contacted and a representative stated that Mithra will <br /> get the facility paperwork showing a matching identification number. Facility was instructed to use another vendor <br /> if Mithra cannot get them the proper paperwork. <br /> Reinspecion on/about: A reinspection fee of$130 per hour may be charged. Page 2 of 2 <br /> EH-03/2015 <br />
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