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o Ul. •e <br /> Body Art Inspection Report Date: May 1,2026 <br /> N �-A San Joaquin County Environmental Health Department Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: PR0548626 <br /> (209)468-3420 Program <br /> �4 �P/ www.sioay.ora/ehd <br /> Element: 4120 <br /> PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> PR0546640 Jennifer Bou(BBP Exp.8/29/26 <br /> Observations and Corrective Actions: <br /> 7. HSC 119314-Sharps containers labeled, used, and disposed of appropriately <br /> OBSERVATIONS: <br /> The sharps waste was mailed back to Solutions in 2025, but a manifest was not available for review. <br /> CORRECTIVE ACTIONS: <br /> Sharp waste containers shall be disposed of by a licensed waste hauler or approved mail back system. Documentation of <br /> proper disposal shall be maintained for 3 years. Provide the EHD with a manifest from Solutions. <br /> 18. HSC 119303 -Client records approved and available-Consent form and questionnaire <br /> OBSERVATIONS: <br /> 1. The medical questionnaire did not include all items listed on Form B. <br /> 2. Ms. Bou is unable to add the lot numbers of the instruments to the client records on Jot Form. Instead, a separate <br /> spreadsheet is used. This practice is not permitted by the EHD. <br /> CORRECTIVE ACTIONS: <br /> 1. The facility's client consent form and medical questionnaire must include all of the information listed in Form B, and are <br /> available for inspection. Include the following on the medical questionnaire and provide a copy to the EHD: <br /> - History of herpes infection at the procedure site. <br /> - History of hemophilia or other bleeding disorders. <br /> -History of cardiac valve disease. <br /> -Requirements for antibiotics prior to surgery or dental procedures. <br /> -Other risk factors for blood borne pathogens. <br /> 2. The facility's client consent form and medical questionnaire must include all of the information listed in Form B, and are <br /> available for inspection. If Jot Form does not allow the addition of the lot number of instruments on the platform, then Ms. Bou is <br /> to either use a different electronic platform for client records or shall begin using paper forms. Provide evidence of correction to <br /> the EHD. <br /> Correct all violations and provide evidence of corrections to the EHD <br /> by May 15, 2026. <br /> Notes: <br /> 1. Inspection report emailed to the facility owner, Jennifer Bou, at adorn beautyink(cDgmail.com. <br /> 2. Per facility owner, the sharps waste was mailed back to Pureway on April 30, 2026. Owner shall keep disposal records for 3 <br /> years. <br /> 3. Sterilization certificates were provided for the Aqua needle cartridges with the lot numbers 202502 and 202602. <br /> 4. The curtains used on the windows and the door to the room are waterproof. Ms. Bou provided curtain specifications to the <br /> EHD. <br /> Reinspection on/about: A reinspection fee of$179 per hour may be charged. Page 2 of 2 <br /> EH-7-1-25 <br />