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Body Art Inspection Report Date: 8-15-2023 <br /> N {1 San Joaquin County Environmental Health Department Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: SR0087036 <br /> (209)468-3420 <br /> Program <br /> \\cq �Foa�'�Pi www.sioay.org/ehd Element: 4103 <br /> PR Number PRACTITIONERIARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> Lynda Diaz BBP Expiration September 20,2023 <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, <br /> and are available for inspection. HSC 119303 <br /> OBSERVATION: Consent form and questionnaire lacks"History of allergic reactions to latex" <br /> CORRECTIVE ACTION: Provide this statement in the questionnaire. <br /> 32. A body art facility shall have floors and walls 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, <br /> ceiling to floor, from nail and hair activities and be separated from all business not related to body art. Approval of co- <br /> located body art facilities are at the discretion of the LEA. A procedure area must be equipped with adequate light to <br /> perform a procedure. Each procedure area shall have lined waste containers. HSC 119314$ 119317 <br /> OBSERVATION: Observed brick wall that is not smooth, nonabsorbent, free of open holes, and washable. <br /> CORRECTIVE ACTION: Provide a wall that is smooth, nonabsorbent, free of open holes, and washable. <br /> CORRECT ALL ITEMS BY AUGUST 29, 2023 <br /> Notes: <br /> 1. Facility performs permanent cosmetics. <br /> 2. Sharps container mail back system company is Sharps Compliance 9220 Kirby Drive#500 Houston, <br /> TX 77054 <br /> 3. Report emailed to Lynda Diaz<lyndadiaz@ymail.com> <br /> 4. IPCP to say they type of disinfectant being used "Caviwipes" <br /> 5. Ensure Client records have a copy of identification/driver's license for proof of age (at least 18 years of age <br /> 6. Operator to contact me when she is ready for final inspection at sramirez(abslgov.org or at 209-616-3069 <br /> Reinspection on/about: A reinspection fee of$162 per hour may be charged. Page 2 of 2 <br /> EH-11/17 <br />