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4 "' Body Art Inspect Report Date: /2" San Joaquin County Environmental Health Department Program RL) :4 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: U 1 (209)468-3420 Program I�-�,1 (� •,c4tiFii �p• www.siogv.org/ehd 1 IC)3 Element: PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME Observations and Corrective Actions: 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)—Provide evidence of sterilization and record of purchase for the needles use by the practitioner.The lot number must corresponds with the lot number on the sterilization certificate. 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)—Provide a written agreement or contract with a licensed waste hauler or mail-back system. 13. Practitioner shall provide evidence of a completed, EHD approved, OSHA Bloodborne Pathogen Training consistent with section 119307. —Provide Bloodborne Pathogen Training Certifcate from an approved source for all practitioners working at the facility. Post the training certificate in a conspicuous place. 16. Client shall be at least 18 years of age to receive a tattoo, permanent cosmetics, or branding. Body piercing, unless performed in the presence of parent or guardian, the client, must be 18 years of age. HSC 119302—All client must be at least 18 years of age. Maintain a copy of their Driver's License with their client consent form. 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—Ensure that all the requirements on Form B are on the client consent form and medical questionnaire. Include the lot number and expiration date of the needles use on the clients are on the client consent form. 19. At the completion of the procedure, the practitioner shall provide postprocedure instructions that include ail elements listed in Form B. HSC 119308(b)—Ensure that all the requirements on Form B are on the after-care instructions. 24. Disinfectant shall have ability to reduce or eliminate the presence of disease-causing microorganisms, including HIV and hepatitis B virus. HSC 119301(k)—Ensure that the disinfectant uses by the practitioners are capable of disinfecting disease-causing microorganisms like HIV and hepatitis B virus. 25. Disinfectant shall be used according to the manufacturer's instructions. HSC 119309(b)- Ensure that enough wet contact time are use to disinfect any surfaces. 26. Any part of a tattooing machine that may touch the practitioner during procedure shall be covered with a disposable plastic sheath. HSC 119311(h)—Ensure that there is a disposable barrier to protect the tattoo machine. 28. Sterilized instrument packs, equipment and jewelry shall be stored in a labeled container or cabinet that is protected from dust or moisture. Sterile instrument packs shall be evaluated before use; instrument packs shall be discarded or reprocessed if condition is compromised. HSC 119315—Ensure that the inks, pigments,instruments,and all applicable tools are stored Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Page 2 of 3 EH-11/17