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U------- <br />Body <br />:-Body Art Inspection Report Date: <br />San Joaquin County Environmental Health Department <br />Program <br />1868 E. Hazelton Ave., Stockton, CA 95205 Record: <br />(209) 468-3420 <br />• N ��/� WWN.siogv.org/ehd Program <br />`rFOR?' Element: <br />PR Number PRACTITIONER/ARTIST NAME <br />Shauna Haro — BBP EXP 9/20/2022 <br />Observations and Corrective Actions: <br />October 6, 2021 <br />SR0084278 <br />4103 <br />I PR Number I PRACTITIONER/ARTIST NAME I <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 />jminimum of 90 days after use. HSC 119315(f) — The sterilization certificate and invoice for instruments Fuzion Artistry <br />LOT #FA2101 and P -Tek Lot #E0020886 were not available. Provide EHD with sterilization certificates for the <br />instruments and provide invoices. <br />11. The procedure area shall be equipped with a sink with hot and cold running water, containerized liquid soap, and single use <br />paper towels dispensed from a wall -mounted, touchless dispenser that is readily accessible to practitioner. HSC 119314(b) — <br />Replace paper towel dispenser in the restroom. Paper towel dispenser is to be wall -mounted and touchless. <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 inspecticn. HSC 119303 — Medical Questionnaire is missing the following languages: <br />•—Mistory of herpes infection at the procedure site <br />• Requirements for antibiotics prior to surgery or dental procedures <br />• -Alher risk factors for blood borne pathogens <br />Include the listed languages and provide EHD with corrected Medical Questionnaire. <br />33. All surfaces and objects in the procedure area, including chairs, armrests, tables, countertops, and trays, shall be in good <br />repair and capable of being disinfected. All counter surfaces and service trays in the procedure area shall have a smooth, <br />durable, and nonabsorbent finish. HSC 119314 — Procedure chair need to be of made of non-absorbment material. <br />Replace the chair and provide photographic proof to EHD. <br />Provide corrections to the EHD by October 20, 2021. <br />Notes: <br />1. The inspection report was emailed to Shauna Haro at sharobeautyCa.yahoo.com. <br />2. Sharps company is used for sharps waste disposal. <br />Reinspection on/about: A reinspection fee of $152 per hour may be charged. Page 2 of 2 <br />EH -11/17 <br />