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EHD Program Facility Records by Street Name
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4100 – Safe Body Art
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PR0546977
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COMPLIANCE INFO
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Entry Properties
Last modified
10/21/2025 12:13:38 PM
Creation date
6/7/2023 2:20:57 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4100 – Safe Body Art
File Section
COMPLIANCE INFO
RECORD_ID
PR0546977
PE
4120 - BODY ART FACILITY-SINGLE USE
FACILITY_ID
FA0022860
FACILITY_NAME
PURE FORM GALLERY & TATTOO (EDGINGTON,WILLIAM)
STREET_NUMBER
213
Direction
W
STREET_NAME
YOSEMITE
STREET_TYPE
AVE
City
MANTECA
Zip
95336
CURRENT_STATUS
Active, billable
QC Status
Approved
Scanner
SJGOV\cfield
Supplemental fields
Site Address
213 W YOSEMITE AVE MANTECA 95336
Tags
EHD - Public
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<br /> <br />Reinspection on/about:__________________. A reinspection fee of $162 per hour may be charged. Page 2 of 2 <br />EH-11/17 <br /> Body Art Inspection Report <br />San Joaquin County Environmental Health Department <br />1868 E. Hazelton Ave., Stockton, CA 95205 <br />(209) 468-3420 <br />www.sjogv.org/ehd <br /> <br />Date: 02/05/2025 <br />Program <br />Record: PR0546977 <br />Program <br />Element: 4120 <br /> <br />R Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> <br />PR0540005 William Edgington (BBP exp. 02/04/2026) <br />PR0548575 Brandon Springer (BBP exp. 05/08/2025) <br />PR0547850 Gabriel Pina (BBP exp. 05/07/2025) <br /> <br />Observations and Corrective Actions: <br /> <br />#3. HSC 119315 - Invoices and log kept for disposable, pre-sterilized equipment <br />OBSERVATION: Sterilization documentation for pre-sterilized needles were not available for review at the time of the inspection. <br /> <br />CORRECTIVE ACTION: Submit sterilization certificates for Kwadron Needle lot numbers 0224 & 0618 to the EHD. <br /> <br /> <br />#33. HSC 119314 - Workstation, surfaces, including chairs, armrests, etc. in good repair <br />OBSERVATION: Two chairs in the procedure area were observed with tears that exposed the inside material/cushion at the foot <br />rest. <br /> <br />CORRECTIVE ACTION: Repair (patching not accepted) or replace the chairs to ensure that all surfaces in the procedure area <br />are smooth, nonabsorbent, and in good repair. Submit photos. <br /> <br /> <br />#35. HSC 119313 - Operation and employee training records present <br />OBSERVATION: The Infection Prevention Control Plan (IPCP) is incomplete. Page 6, Section P (procedure for an accidental <br />spill) does not adequately discuss steps taken to clean-up & disinfect after an accidental spill of sharps. <br /> <br />CORRECTIVE ACTION: Revise Section P of the IPCP and submit a copy to the Environmental Health Department (EHD). <br /> <br /> <br /> <br /> <br /> <br /> Correct all violations and provide evidence of corrections to the EHD <br />by 03/05/2025. <br /> <br /> <br />Notes: <br />1. Inspection report emailed on 02-13-2025 to facility owner William Edgington at billythekidd5@gmail.com <br />2. Stericycle is utilized by the facility for sharps waste disposal. <br />3. Questionnaire and consent form templates were viewed electronically at the time of the inspection. Submit copies to <br />the EHD. <br />4. Ensure that the repaired holes in the wall are repainted with a gloss finish. <br />5. Ensure EHD is notified before any remodeling occurs at the facility. <br />
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