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r�oPa.!1t X02 Body Art Inspect* Report date: San Joaquin County Environmental Health Department Program 1868 E. Hazelton Ave., Stockton, CA 95205 Record: cq<eFoa (209) 468-3420 Program �P www.siogv.org/ehd Element: PR Number PRACTITIONERIARTIST NAME 537522 John Hullar Observations and Corrective Actions: 6-a�r• ��r PR Number PRACTITIONER/ARTIST NAME Q1 a0 6. A facility that uses single use instruments shall maintain record of purchase, log of procedures, names of practitioner and client, date of procedure, instruments used, and written evidence from the manufacture that the instruments have undergone sterilization. The record of purchase, evidence of sterilization, type and number of instruments used shall be maintained for a minimum of 90 days after use. HSC 119315(f) - Written Proof on company or laboratory letterhead showing that the presterilized instruments have undergone a sterilization Process. Written proof shall clearly identify the instruments sterilized by name or item number and shall identify the lot or batch number of the sterilizer run. 7. The sharps waste container shall be within arm's reach and labeled with the word "sharps waste" or with the biohazard symbol and the word "Biohazard". Sharp waste containers shall be disposed by a licensed waste hauler or approved mail back system. Documentation of proper disposal shall be maintained for 3 years. HSC 119314(e) 11. The procedure area shall be equipped with a sink with hot and cold running water, containerized liquid soap, and single use paper towels dispensed from a wall -mounted, touchless dispenser that is readily accessible to practitioner. HSC 119314(b) 13. Practitioner shall provide evidence of a completed, EHD approved, OSHA Bloodborne Pathogen Training consistent with section 119307. 18. The facilities client consent form and medical questionnaire must include all of the information listed in Form B, and are available for inspection. HSC 119303 - Include the following statement on consent forms: Tattoo inks, dyes, and pigments have not been approved by the federal Food and Drug Administration and that the health consequences of using these products are unkown. 31. A body art facility shall be separated from any residential areas used for sleeping, bathing, or meal preparation and shall not share a common entrance or toilet facility with residence. The toilet facility must have a sink with hot and cold water, containerized liquid soap, and single -use paper towels that are dispensed from a wall -mounted, touchless dispenser. HSC 119314 Unless otherwise noted, Corrective Action is due within 30 days. Reinspecion on/about: A reinspection fee of $125 per hour may charged. Page 2 of 2 EH -04/2014