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-:�- f / A� <br /> Body Art Inspect Report Date: S I I <br /> San Joaquin County Environmental Health Department Program <br /> i 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: <br /> (209)468-3420 <br /> Program <br /> ` !FqR www.siogv.orp/ehd <br /> Element: <br /> PR Number PRACTITIONERIARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> PR0539116 Esau Mendoza-Permit+BBP posted PR0539504 Jose Hernandez-Permit+BBP posted <br /> PR0538823 Erick D.Jimenez-Permit+BBP posted PR0537638 So holie Pak-unpermitted, BBP current <br /> PR0537993 Ruben Benites-no longer working here <br /> PRO540006 Jessie Witt-Permit+BBP 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) <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 <br /> 25. Disinfectant shall be used according to the manufacturer's instructions. HSC 119309(b) <br /> 32. A body art facility shall have floors, walls, and ceilings that are smooth, nonabsorbent, free of open holes, and washable. <br /> The body art facility shall be free of insect and rodent infestation. The procedure area must be separated, by a wall, ceiling to <br /> floor, from nail and hair activities and be separated from all business not related to body art. Approval of co-located body art <br /> facilites are at the discretion of the LEA. A procedure area must be equipped with adequate light to perform a procedure. Each <br /> procedure area shall have lined waste containers. HSC 119314& 119317 <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 /> 37. A body art facility shall not conduct business without a valid health permit. A person shall not perform body art without a valid <br /> registration and a permitted facility. A body art facility shall notify the LEA in writing within 30 days of resignation, termination of a <br /> practitioner. Anew hire or apprentice must be registered the EHD prior to performing body art at the facility. HSC 119312 & <br /> 119306 <br /> Unless otherwise noted, all violations noted above must be corrected within 30 days. <br /> Notes: 1.) During this inspection Sophollie Pak went to EHD to pay his registration fee. <br /> Reinspecion on/about: A reinspection fee of$130 per hour may be charged. Page 2 of 2 <br /> EH-03/2015 <br />