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UI <br /> Body Art Inspection Report Date: 12116/21 <br /> tial San Joaquin County Environmental Health Department Program <br /> 1868 E. Hazelton Ave., Stockton, CA 95205 Record: New PR# <br /> (209) 468-3420 <br /> �o vc • v .sioay.ora/ehd Program <br /> Element: 4120 <br /> PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> Salomon Barbosa Mario Barbosa <br /> Joanne Barbosa <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) — A sterilization certificate was not available for Salomon Barbosa's Quelle <br /> cartridge with lot #2021106. A sterilization certificate was not available for Joanne Barbosa's XYAOY4 blades or for the <br /> Charm Princesse cartridge with lot #E0040825. Provide EHD with a copy of the sterilization certificates for the <br /> cartridges and blade mentioned above. <br /> 7. The sharps waste container shall be within arm's reach and labeled with the word "sharps waste" or with the biohazard symbol <br /> and the word " Biohazard". Sharp waste containers shall be disposed by a licensed waste hauler or approved mail back system . <br /> Documentation of proper disposal shall be maintained for 3 years. HSC 119314(e) — A contract was not available from <br /> Barnett Medical Services, sharps hauler. Provide EHD with a copy of the contract. <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 — Different consent forms and medical questionnaires will be used for permanent <br /> cosmetics and tattoos. The consent form and medical questionnaire did not include all of the information listed in Form <br /> B. <br /> Include the following on the permanent cosmetic consent form and provide a copy to the EHD: <br /> - Client is at least 18 years of age. <br /> - Description of procedure. <br /> - Statement regarding permanent nature of procedure. <br /> - Notice that inks are not FDA approved and health consequences are unknown . <br /> Include the following on the tattoo consent form and provide a copy to the EHD: <br /> - Description of what the client should expect following the procedure. <br /> - Notice that inks are not FDA approved and health consequences are unknown . <br /> Include the following on the permanent cosmetic medical questionnaire and provide a copy to the EHD: <br /> - History of herpes infection at the procedure site. <br /> - History of allergic reactions to latex. <br /> - History of allergic reactions to antibiotics. <br /> - History of hemophilia or other bleeding disorders. <br /> - Historyof cardiac valve disease. <br /> - Other risk factors for blood borne pathogens. <br /> Include the following on the tattoo medical questionnaire and provide a copy to the EHD : <br /> - History of herpes infection at the procedure site. <br /> - History of diabetes. <br /> - History of allergic reactions to latex. <br /> - History of allergic reactions to antibiotics. <br /> - History of hemophilia or other bleeding disorders. <br /> - History of cardiac valve disease. <br /> Other risk factors for blood borne pathogens. <br /> - Current medications. <br /> Requirements for antibiotics prior to surgery or dental procedures. <br /> Reinspection onlabout: A reinspection fee of $152 per hour may be charged. Page 2 of 3 <br /> EH-11/17 <br />