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u'M Body Art Inspects Report Date: 10 1a5 rl�q a�G San Joaquin County Environmental Health Department Program 9 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: c P, (209)468-3420 Program www.sioqv.org/ehd Element: g O PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME PR0537649 Americo Salazar Jr(BBP exp. 10-20-20). Observations and Corrective Actions: 6. A facility that uses single use instruments shall maintain record of purchase, log of procedures, names of practitioner and 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)—A sterilization certificate was not available for lot#170402. Provide sterilization certificate to the EHD. 7. The sharps waste container shall be within arm's reach and labeled with the word "sharps waste"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)—Disposal receipt was not available on site. Provide a sharps disposal receipt to the EHD. 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—Client consent forms were not on site. Provide client consent form for the last 3 years to the EHD. 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 client consent form and medical questionnaire do not include all the information listed in Form B. Include the following on the consent form: a. Description of the the procedure. b. Description of what the client should expect following the procedure. Include the following on the medical questionnaire: a. History of herpes"infection at the procedure site." b.Other risk factors for bloodborne pathogens 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 does not include all the information listed on Form B. Include the signs and symptoms of infection on the postprocedure instructions. 28. Sterilized instrument packs, equipment and jewelry shall be stored in a labeled container or cabinet that is protected from dust or moisture. Sterile instrument packs shall be evaluated before use; instrument packs shall be discarded or reprocessed if condition is compromised. HSC 119315—Ink was not stored in a cabinet. Store inks in a cabinet to prevent contamination. Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Page 2 of 3 EH-11/17 �.