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Body Art <br /> Inspection Report <br /> Date: <br /> June 2, 202 <br /> 1 <br /> San Joaquin County Environmental Health Department Program <br /> 1868 E. Hazelton Ave., Stockton, CA 95205 Record: PR0546901 <br /> (209) 468-3420 <br /> .sioevom/elrd Program <br /> Element: 4120 <br /> PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> PR0539116 Esau Mendoza (BBP exp. 518122 PR0538099 Mario Morales BBP exp. 1017/21 <br /> PRO537449 Phillip Mendoza (BBP exp. 6/1/22 PRO544526 Carlos Vargas (BBP exp. 5/10/22 <br /> PR0544540 Joseph Sandoval BBP exp. 5/10/22 PRO545169 Linda Hernandez <br /> PRO546842 Luis Villa omez Alvarado BBP exp. 5/11/22 PRO546904 Jazzmin Martinez (BBP exp. 5/11/22 <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) — Esau's Cheyenne needle cartridge with lot #2020-37-010 and Mario's <br /> Cheyenne needle cartridge with lot #2021 -10-034 did not correlate with the sterilization certificate provided. Provide <br /> EHD with a sterilization certificate for the above mentioned needles. <br /> 13. Practitioner shall provide evidence of a completed, EHD approved , OSHA Bloodborne Pathogen Training consistent with <br /> section 119307, — A Bloodborne Pathogen Training Certificate was not available for Linda Hernandez. Provide a copy of <br /> Linda's certificate to the EHD. <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 records were not signed by the practitioners, Ensure all client records <br /> are signed by the practitioners. <br /> Unless otherwise noted , submit all corrections to the EHD by June 17 , 2021 . <br /> Notes: <br /> 1 . Inspection report emailed to facility owner, Esau Mendoza, at luckvvoutattoo(ai)vahoo.com . <br /> 2. Barnett Medical is used for sharps waste disposal . The last pickup was on May 21 , 2021 . <br /> 3, Walter Morato-Grado is the Manager for the shop. A current Bloodborne Pathogen Training Certificate and Hepatitis B <br /> declination form were provided to EHD . <br /> Reinspection onlabout: A reinspection fee of $152 per hour may be charged. Page 2 of 2 <br /> EH-11/17 <br />