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)0 Cp. Body Art Inspection Report Date: September 6,2024 Qrr , � San Joaquin County Environmental Health Department Program .: 1868 E Hazelton Ave.,Stockton,CA 95205 Record: AR2400988 (209)468-3420 c •;^' _' P wwN.spgv.org/ehd Program Element: 4103 18. HSC 119303 -Cliert records approved and available -Consent form and questionnaire OBSERVATIONS: 1. The consent form did not include parent/guardian signature for minors receiving body piercing. 2. Question #3 of t-ie medical questionnaire states"Do you have any communicable diseases or other risk factors for bloodborne pathogens? (HIV, AIDS, HEPATITIS)" CORRECTIVE ACTIONS: 1. The facility's client consent form and medical questionnaire must include all of the information listed in Form B, and are available for inspection. Include a section on the consent form to include parent/guardian signature. Provide an updated copy of the form to the EH:). 2. The facility's client consent form and medical questionnaire must include all of the information listed in Form B, and are available for inspection. HIV, AIDS and HEPATITIS should be removed to make the question broader to other bloodborne pathogens. Update the questionnaire and provide EHD with a copy. 31. HSC 119314- Areas separated/no living or sleeping quarters OBSERVATIONS: 1. The wall under tie sink and next to the light switch are in need of repair in the restroom. 2. The restroom is lacking a baseboard. CORRECTIVE ACTIONS: 1. The toilet facility must have a sink with hot and cold water, containerized liquid soap, and single-use paper towels that are dispensed from a wall-mounted, touchless dispenser. Repair the wall under the restroom sink and next to the light switch. 2. The toilet facility must have a sink with hot and cold water, containerized liquid soap, and single-use paper towels that are dispensed from a wall-mounted, touchless dispenser. Install a baseboard in the restroom. 32.HSC 119314- =loors and walls clean and in good repair, adequate light OBSERVATIONS: The frame next to statio-i#2 is not sealed. CORRECTIVE ACTIONS: A body art facility shall have floors, walls, and ceilings that are smooth, nonabsorbent, free of open holes, and washable. Seal the wooden frame nex-to station#2 from the floor to the ceiling. 33. HSC 119314- dVorkstation,surfaces, including chairs, armrests, etc. in good repair OBSERVATIONS: The armrests have beer removed from the procedure chairs causing absorbent material from the chair to be exposed. CORRECTIVE ACTIONS: All surfaces and otjects in the procedure area, including chairs, armrests, tables, countertops, and trays, shall be in good repair and capable of being disinfected. All counter surfaces and service trays in the procedure area shall have a smooth, durable, and nonabsorbent finish. Repair/replace procedure chairs. Correct all violations and pay all applicable fees prior to scheduling the final inspection. Reinspection on/about: A reinspection fee of$172 per hour may be charged. Page 3 of 4 EH-11/17