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P UIN <br />`cec <br />Body Art Inspection Report <br />Date: <br />a, <br />San Joaquin County Environmental Health Department <br />Program <br />1868 E. Hazelton Ave., Stockton, CA 95205 <br />Record: <br />(209) 468-3420 <br />�.n•...�,.._,;.,,�^,' <br />www.siogv.org/ehd <br />Program <br />Element <br />PR Number PFACTITIONER/ARTIST NAME <br />Phuonq Nquven (BBP exp. 9/29/22) <br />Observations an 1 Corrective Actions: <br />8/11/22 <br />S R0084943 <br />4103 <br />I PR Number I PRACTITIONER/ARTIST NAME I <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 - Client consent form missing the following: description of the procedure, <br />description of what the client should expect following the procedure, indications when to seek medical attention -not to <br />seek an RN but a practitioner, history of herpes infection at the prceodure site, history of allergic reactions to latex, <br />history of allergic reactions to antibiotics, history of hemophilia or other bleeding disorders, history of cardiac valve <br />disease, requirements for antibiotics prior to surgery or dental prceodures, and other risk factors for bloodborne <br />pathogens. Ensure all client records are complete. <br />32. A body art facility shall have floors, walls, and ceilings 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, ceiling to <br />floor, from nail and hair activities and be separated from all business not related to body art. Approval of co -located body art <br />facilities are at the discretion of the LEA. A procedure area must be equipped with adequate light to perform a procedure. Each <br />procedure area sr all have lined waste containers. HSC 119314 & 119317 —Walls have holes and some areas patched. The <br />walls have a matte finish. Repairlpatch the holes and paint with semi -gloss or gloss paint. Paint the walls with semi- <br />gloss or gloss paint. <br />Unless otherwise noted, submitted all corrections to the EHD by August 24, 2022 <br />and pay all applicable fees prior to opening. <br />Notes: <br />1. Inspection report emailed to, Tue Pham, at tuep444@gmail.com. <br />2. EnviroMed Safety and Compliance will be 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 />