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SAN 10AQU I N Environmental Health Department <br /> Body Art Inspection Report <br /> Facility Name: Facility Address: Date: <br /> OLD VINE TATTOO(PALMER, JOSH) 521 W KETTLEMAN LN, LODI July 22, 2021 <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Item# Remarks <br /> 13 HSC 119307 Bloodborne Pathogen training. <br /> Practiticner shall provide evidence of a completed, EHD approved, OSHA Bloodborne Pathogen Training consistent <br /> with section 119307. -A ent Bloodborne Pathogen training certificate was not available for Joshua Palmer. <br /> Provide EHD wit a current certificate. <br /> 18 HSC 113303 Client records approved and available-Consent form and questionnaire. <br /> The facilities client consent form and medical questionnaire must include all of the information listed in Form B, and <br /> are ava table for inspection. HSC 119303-Consent for missing lot#for instruments used, photocopy of 1.D. <br /> cards, practitioner name, and incomplete co rm. <br /> 32 HSC 119314, 119317 Floors and walls clean and in good repair, adequate light. <br /> A body art facility shall have floors, walls, and ceilings that are smooth, nonabsorbent, free of open holes, and <br /> washable. The body art facility shall be free of int rodent infestation. The procedure area must be separated, <br /> by a wall, ceiling to floor, from nail and hair actio secand be separated from all business not related to body art. <br /> Approval of co-located body art facilities the discretion of the LEA.A procedure area must be equipped with <br /> adequate light to perform a procedum.- ach procedure area shall have lined waste containers. HSC 119314 & <br /> 119317-Waste container-irr'tfi-e—procedure room did not have liners. Provide liners for waste container and provide <br /> photographic proof to EHD. <br /> i <br /> 33 HSC 119314 Workstation, surfaces, including chairs, armrests, etc. in good repair. <br /> All surfaces and objects in the procedure area, including chairs, armrests, tables, countertops, and trays, shall be in <br /> good repair and capable of being disinfected. A unter surfaces and service trays in the procedure area shall <br /> have a smooth, durable, and nonabsorbe 'nish. HSC 119314-The procedure table has a tare on it, in the VA DIY'4t" � <br /> procedure room. Repair/replace ocedure table and provide photographic proof of correction to EHD. <br /> 35 HSC 119313 Operation and employee training records present. <br /> OperatbDn and employee training records shall be maintained for 3 rs and made available for inspection. A <br /> written Infection Prevention and Control Plan (IPCP) sh aintained, followed and updated. HSC 119313- <br /> IPCP aid training records were not available. Provide IPCP and training records to EHD. <br /> 37 HSC 119312 119306 Permits obtained and available. <br /> A body art facility shall not conduct business without a valid health permit. A person shall not perform body art <br /> without a valid registration and a permitted facility. A body art facility shall notify the LEA in writing within 30 days of <br /> resignation, termination of a practitioner. A new hire or apprentice must be re Istered the EHD prior to performing <br /> body art at the facility. HSC 119312 & 119306-Jose Aleman, Carl6ssi, an j1 is is performing body art at facility <br /> without a permit. <br /> Nei c6m It t <br /> Overall Inspection Comments: <br /> OBSERVATIONS <br /> Bloodborne pathogen training source: <br /> Chemical disinfectant used: Wet contact time: <br /> FA0026192 PR0546258 SCO02 07/22/2021 <br /> EHD Rev.6/15/202" Page 3 of 4 Body Art OIR <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br />