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Body Art Inspection Report Date: San Joaquin County Environmental Health Department Program 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: (209)468-3420 `,c.. � .•�P' Program www.siogv.org/ehd Element: PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONEP./ARTIST NAME Observations and Corrective Actions: 6. A facilitythat uses single use instruments shall maintain record of purchase, to of procedures, names of practitioner and 9 p 9 p 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)—The blades used is not labeled with the manufacturers name and a sterilization certificate was not available. Provide EHD with a sterilization certificate of blades that will be used at the site. 7. The sharps waste container shall be within arm's reach and labeled with the word "sharps%aste" 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) — Practitioner does not have a contract with a sharps waste hauler or mail back system. Provide EHD with documentation of licensed waste hauler or mail back system. 12. Practitioner shall provide evidence of current hepatitis B vaccination or hepatitis B immunity or comply with current federal OSHA hepatitis B vaccination declination requirements. HSC 119306(c)— Proof of Hepatitis 3 vaccination was not provided. Provide EHD with record of Hepatitis B vaccination or a Hepatitis B declination form. 13. Practitioner shall provide evidence of a completed, EHD approved, OSHA Bloodborne Pathogen Training consistent with section 119307. —A current Bloodborne Pathogen Training Certificate was not available. Provide the EHD with a current Bloodborne Pathogen Certificate. 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—The medical questionnaire and client consent forms were not available for review. Provide EHD with a copy of the medical questionnaire and consent form for review. 19. At the completion of the procedure, the practitioner shall provide postprocedure instructions that include all elements listed in Form B. HSC 119308(b)—The postprocedure instructions were not available for review. Provide EHD with the postprocedure instructions for review. 27. Products applied to skin prior to tattooing or application of permanent cosmetics, including, but not limited to, stencils, marking and transfer agents, shall be single use and discarded into a waste container at the end of the procedure. HSC 119311(a)—The marking pencil was not single use. Obtain single use disposable marking pencils, provide photographic evidence to the EHD. Date: 9/10/20 Program Record: SR0082525 Program Element: 4103 Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Page 2 of 3 EH-11/17