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o <br /> Body Art Inspection Report Date: October9,2025 <br /> N { San Joaquin County Environmental Health Department Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: AP2502730 <br /> (209)468-3420 9 <br /> www.sioov.ora/ehd Pro ram <br /> 9tiF o Element: 4103 <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. Include the following on the SMP medical questionnaire and provide a copy to the EHD: <br /> -History of herpes infection at the procedure site. <br /> -History of diabetes. <br /> -History of allergic reactions to latex. <br /> -History of allergic reactions to antibiotics. <br /> - History of hemophilia or other bleeding disorders. <br /> - History of cardiac valve disease. <br /> -Current medications. <br /> - Requirements for antibiotics prior to surgery or dental procedures. <br /> -Other risk factors for bloodborne pathogens. <br /> 3. 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 permanent cosmetics consent form and provide a copy to the EHD: <br /> -Statement regarding the permanent nature of the procedure. <br /> 19. HSC 119303, 119308-Appropriate aftercare instructions given to client <br /> OBSERVATIONS: <br /> Aftercare instructions for permanent cosmetics was not provided. <br /> CORRECTIVE ACTIONS: <br /> At the completion of the procedure, the practitioner shall provide postprocedure instructions that include all elements listed in <br /> Form B. Include the following in the aftercare instructions and provide a copy to the EHD: <br /> - Information on proper care for procedure site. <br /> - Restrictions on physical activities. <br /> - Signs and symptoms of infection. <br /> - Indications when to seek medical care. <br /> 32. HSC 119314-Floors and walls clean and in good repair, adequate light <br /> OBSERVATIONS: <br /> Gap observed in the procedure area between the baseboard and the floor. <br /> CORRECTIVE ACTIONS: <br /> A body art facility shall have floors, walls, and ceilings that are smooth, nonabsorbent, free of open holes, and washable. Seal <br /> the gap between the baseboard and the floor. <br /> Correct all observations and pay all applicable fees prior <br /> to scheduling the final inspection. <br /> Notes: <br /> 1. Inspection report emailed to facility owner, Britteni Chandler, at thin kinkbeauty angmail.com. <br /> 2. The room at the back of the facility is not approved for body art services, unless a sink is installed inside the room. Facility <br /> owner is to contact the EHD for a consultation, if room will be used for body art in the future. <br /> 3. The sharps waste was disposed on August 8, 2025. A manifest was provided by the facility owner. <br /> 4. Opti-Cide disinfectant and Cavi-wipes will be used at the facility. <br /> 5. Each practitioner at the facility will have their own consent forms, after-care instructions and medical questionnaires. <br /> Reinspection on/about: A reinspection fee of$179 per hour may be charged. Page 3 of 3 <br /> EH-7-1-25 <br />