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Body Art Inspectieport Date: <br /> 12, <br /> !d I q <br /> San Joaquin County Environmental Heafth Department Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: <br /> �P (209)468-3420 Program <br /> fFORa www.siogv.org/ehd <br /> Element: 7 <br /> PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> PR0526732 James McGovern,1313P CM 4/3/2019 <br /> PRO542032 John Holcomb,BBP CM 1/5/2020 <br /> Observations and Corrective Actions: <br /> 6. A facility that uses single use instruments shall maintain record of purchase, log of procedures, names of practitioner and <br /> client, date of procedure, instruments used, and written evidence from the manufacture that the instruments have undergone <br /> sterilization. The record of purchase, evidence of sterilization, type and number of instruments used shall be maintained for a <br /> minimum of 90 days after use. HSC 119315(f) <br /> Sterilization records were not available for lots in use in the facility. Submit photographs of two lots currently in use in <br /> the facility along with matching sterilization certificates to the EHD by 12/24/2019. <br /> 33. All surfaces and objects in the procedure area, including chairs, armrests, tables, countertops, and trays, shall be in good <br /> repair and capable of being disinfected. All counter surfaces and service trays in the procedure area shall have a smooth, <br /> durable, and nonabsorbent finish. HSC 119314 <br /> Message Table surface and a chair in the procedure area have tears. Repair surface by 1/1012019. <br /> Notes: <br /> 1) Client records were available for review. The client consent form, medical questionnaire, and aftercare instructions have <br /> the required information. The forms are filled-out completely with lot numbers and identification recorded. <br /> 2) Stericycle is the licensed medical waste hauler providing sharps disposal for the facility. The last pick-up was on <br /> 10/17/19. <br /> 3) Handwash sinks have hot water, soap and touchless paper towel dispensers. <br /> 4) Permits and bloodborne pathogen certificates are posted for both artists. <br /> Unless otherwise stated, all corrections are to be completed by 12/24/2019. <br /> Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Page 2 of 2 <br /> EH-11/17 <br />