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Body Art <br /> Inspection Report <br /> Date: <br /> December 1 <br /> ,2023 <br /> San Joaquin County Environmental Health Department Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: PRO515394 <br /> (209)468-3420 <br /> .sioay.om/ehd Program <br /> Element: 4120 <br /> Specialist(Pdnt): Sandip Singh Specialist(Signature): sff % TAff# Phone:209-468-3526 <br /> PR Number PRACTITIONERIARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> PR0515393 Jon Highland BGP Exp 11/8/24 PR0537374 Ricardo Cardenas(BBP Exp 11/28/24 <br /> PR0537371 Daniel Juga BBP Ex 3/27/24 PR0539346 Krystal Betancourt BBP Exp 8/9/24 <br /> PR0541902 Jessica Orsua BBP Ex 8/24/24 PR0546830 Ashley Hess BBP Exp 11/7/24 <br /> Observations and Corrective Actions: <br /> 13. Practitioner shall provide evidence of a completed, EHD approved, OSHA Bloodborne Pathogen Training consistent <br /> with section 119307. <br /> OBSERVATION: <br /> Jon Highland's Bloodborne Pathogen Training Certificate was not from an approved course. <br /> CORRECTIVE ACTION: <br /> An updated list of approved training courses was provided to Mr. Highland. Provide EHD with a current certificate from the list. <br /> 18. The facilities client consent form and medical questionnaire must include all of the information listed in Form B, <br /> and are available for inspection. HSC 119303 <br /> OBSERVATION: <br /> 1. The consent form did not include all of the items listed on Form B. <br /> 2. The medical questionnaire did not include all of the items listed on Form B. <br /> 3. Some of the client records were missing the photo ID, lot numbers for the needle cartridges, artist name and missing the <br /> description of the tattoo. <br /> CORRECTIVE ACTION: <br /> 1. Include the following information on the consent form and provide a copy to the EHD: <br /> - Description of what the client should expect following the procedure. <br /> 2. Include the following information 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 /> -Current medications. <br /> 3. Ensure all client records are complete with the photo ID, lot numbers, artist names and description of the tattoo(s). Ensure <br /> client records are available for the last 3 years for review. <br /> 32. A body art facility shall have floors,walls, and ceilings that are smooth, nonabsorbent, free of open holes, and <br /> washable. The body art facility shall be free of insect and rodent infestation. The procedure area must be separated, by <br /> a wall,ceiling to floor, from nail and hair activities and be separated from all business not related to body art. Approval <br /> of co-located body art facilities are at the discretion of the LEA. A procedure area must be equipped with adequate light <br /> to perform a procedure. Each procedure area shall have lined waste containers. HSC 119314& 119317 <br /> OBSERVATION: <br /> 1. A hole was observed on the second floor wall next to the chair by the stairs. <br /> 2. The wall next to Daniel Juge's and Ashley Hess' procedure area sinks were damaged. <br /> 3. Holes, a crack and scuff marks were observed on the walls of Jessica Orsua's procedure area. <br /> Reinspection on/about: A reinspection fee of$162 per hour may be charged. Page 2 of 4 <br /> EH-11/17 <br />