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4100 – Safe Body Art
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PR0541638
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COMPLIANCE INFO
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Last modified
2/29/2024 1:57:47 PM
Creation date
3/31/2021 3:45:10 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4100 – Safe Body Art
File Section
COMPLIANCE INFO
RECORD_ID
PR0541638
PE
4120
FACILITY_ID
FA0023861
FACILITY_NAME
RENAISSANCE SALON AND SPA (GRAFFIN, ELISABETH)
STREET_NUMBER
111
Direction
N
STREET_NAME
CHURCH
STREET_TYPE
ST
City
LODI
Zip
95240
CURRENT_STATUS
02
SITE_LOCATION
111 N CHURCH ST
P_LOCATION
02
QC Status
Approved
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SJGOV\cfield
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EHD - Public
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Body Art Insp n Report f Date: <br /> San Joaquin County Environmental Health Department Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: 1�Wro- Y <br /> (209)468-3420 Program <br /> c p e" v.sLd Element: �/ZQ <br /> PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> PR0541638 Kirsten Patterson:BBP posted,permit not posted <br /> PRO541640 Gayle Nanette Witt:BBP posted,permit not posted <br /> PRO541680 Stacey Moffat:BBP and permit not posted <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)-Contact manufacturer, Everlasting Brows,for sterilization records. <br /> 13. Practitioner shall provide evidence of a completed, EHD approved, OSHA Bloodborne Pathogen Training consistent with <br /> section 119307. <br /> 16. Client shall be at least 18 years of age to receive a tattoo, permanent cosmetics, or branding. Body piercing, unless <br /> performed in the presence of parent or guardian, the client, must be 18 years of age. HSC 119302-Provide copy of client's <br /> driver's license/identification and keep with client records. <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-Include for consent form: that inks are not FDA approved and health consequence: <br /> are unWpwn. Include for medical questionnaire: history of allergic reactions for antiobiotics, history of cardiac valve <br /> disease, requirements for antibiotics prior to surgery or dental procedures, and other risk factors for bloodborne <br /> pathogens. <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 /> Notes: <br /> 1) Post BBP in a conspicuous place. <br /> 2) Post current permit. <br /> 3) Maintain an updated copy of the Infection Prevention and Control plan on site. <br /> Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Page 2 of <br /> EH-11/17 <br />
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