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Body Art Inspect4b InspectReport / q <br /> Date: <br /> San Joaquin County Mironmental Health Department Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 <br /> %} Record: <br /> (209)468-3420 <br /> <'IFoga` www siogv.ora ehd Program <br /> Element: <br /> PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> PR0537492 Sara Price <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)—Provide record of purchase and evidence of sterilization (blades: lot <br /> number 867542 and lot number: ISO 9002)for the purchased blades to the EHD. Includes the lot number and expiration <br /> date on the client consent form. <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)—Provide a contract or written agreement <br /> with a licensed waste hauler or approved mail-back system to the EHD. <br /> 16. Client shall be at least 18 years of age to receive a tattoo, permanent cosmetics, or branding. Body piercing, unless <br /> performed in the presence of parent or guardian, the client, must be 18 years of age. HSC 119302—Maintain a copy of the <br /> client identification card with their records. <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— <br /> On the client consent form, includes the following statements: <br /> 1. Client is at least 18 years of age <br /> 2. Statement regarding the permanent nature of the procedure <br /> 3. Notice that inks are not FDA approved and health consequences are unknown <br /> On the medical questionnaire includes the following: <br /> 1. History of herpes infection at the procedure sites <br /> 2. History of allergic reactions to latex and antibiotics <br /> 3. History of hemophilia or other bleeding disorders <br /> 4. History of cardiac valve disease <br /> 5. Requriements for antibiotics prior to surgery or dental procedures <br /> 6. Other risk factors for blood borne pathogens <br /> 19. At the completion of the procedure, the practitioner shall provide postprocedure instructions that include all elements listed in <br /> Form B. HSC 119308(b) <br /> Include the following on the aftercare instructions: <br /> 1. Signs and symptoms of infection <br /> 2. Indications when to seek medical care <br /> 27. Products applied to skin prior to tattooing or application of permanent cosmetics, including, but not limited to, stencils, <br /> marking and transfer agents, shall be single use and discarded into a waste container at the end of the procedure. HSC <br /> 119311(a)—Products applied to the skin should be single use. <br /> Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Page 2 of 3 <br /> EH-11/17 <br />