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ur <br />Body Art Inspection Report Date: April 4, 2022 <br />y' tia San Joaquin County Environmental Health Department Program <br />1668 E. Hazelton Ave., Stockton, CA 95205 Record: SR0085073 <br />(209) 468-3420 <br />�P'• WWW.$i0ny.or97ehd Program <br />Element: 4103 <br />PR <br />Number <br />PRACTITIONER/ARTIST <br />NAME <br />Belen Eisner <br />Observations and Corrective Actions: <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 medical questionnaire did not contain all of the information listed in Form B. <br />Include the following elements on the medical questionnaire and proved corrected form to the EHD: <br />- History of hemophilia or other bleeding disorders. <br />- Other risk factors for Bloodborne pathogens. <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 />facilities 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— There were gaps between the floor and the wall <br />beams. Seal the area between the floor and the wall beams. <br />Correct all observations and pay all applicable fees by <br />April 21, 2022. <br />Notes: <br />1. Inspection report was emailed to facility owner, Belen Eisner, at BDiaz anc2lmm.com. <br />2. Ensure marking utensils are one time use (disposable). <br />3. Practitioner will be using Phi Brow blades. The lot number on the sterilization certificate correlates with the lot number on <br />the product box and not with the blade package. <br />4. Practitioner shall change out the partition in the future, to a partition that is nonabsorbent. The window drapes are <br />approved by the EHD. <br />Relnspectlon onlabout: A reinspection fee of $152 per hour may be charged. Page 2 of 2 <br />EH -11117 //�� <br />l.-y� <br />