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Body Art Inspection Report Date: June 17, 2021 <br />N; San Joaquin County Environmental Health Department Program <br />1868 E. Hazelton Ave., Stockton, CA 95205 Record: PRO537388 <br />(209)468-3420 <br />°x wvrvi.sionv.oralehd Program <br />Element: 4121 <br />PR Number <br />PRACTITIONER/ARTIST NAME <br />PRO537389 <br />Josh Hughes <br />PR0541881 <br />Kevin Murphy BBP exp. 1/14121 <br />PR0546643 <br />Kaitlin Kain (BBP exp. 1013/21 <br />Observations and Corrective Actions: <br />PR Number <br />PRACTITIONER/ARTIST NAME <br />PR0541300 <br />Scott Bender (BBP exp. 1/14/22 <br />PR0544031 <br />Jennifer Culotta (BBP exp. 5/9/22 <br />updated. <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) —A sterilization certificate was not available for the Tat Soul cartridges for <br />lot numbers 200701 and 0919. Provide EHD with sterilization certificates for the above mentioned cartridges. <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, touchless dispenser that is readily accessible to practitioner. HSC 119314(b) — <br />The paper towel dispenser in the sterilization room did not contain paper towels. — Corrected on site. <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 — The client consent form and medical questionnaire did not include all of the <br />information listed on Form B. <br />Include the following on the consent form: <br />- Description of what the client should expect following the procedure. <br />- Notice that inks are not FDA approved and health consequences are unknown. <br />Include the following on the medical questionnaire: <br />- History of hemophilia or other bleedinq disorders. <br />- Other risk factors for blood borne pathogens. <br />Unless otherwise noted, correct all violations and provide evidence of corrections to <br />the EHD by July 2, 2021. <br />Notes: <br />1. Inspection report was emailed to Galen Reyes, Shop Manager, at emeraldtattoolodit�gmail.com. <br />2. Kristy Streat, Breana Zeingeberg, Samantha Manka and Richard Rawlins are no longer practicing at the facility. <br />3 Stericycle is used for sharps waste disposal. Sharps waste last disposed on 3/26/21. <br />4. The IPCP was updated in January 2021, a copy was received by the EHD. <br />5. The last <br />training was <br />provided <br />to practitioners on 11/18/20. <br />Ensure training <br />is provided. on an annual basis or when IPCP is <br />updated. <br />Reinspection onlabout: A reinspection fee of $152 per hour may be charged. Page 2.of 2 <br />EH -11/17 <br />