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°P°U'" co <br />Body Art Inspect* Report <br />San Joaquin County Environmental Health Department <br />1868 E. Hazelton Ave., Stockton, CA 95205 <br />(209) 468-3420 <br />cq<;F RN`P <br />wwvv.siogv.org/ehd <br />PR <br />Observations and Corrective Actions: <br />Date: /V ! q -% <br />Program <br />Record: <br />Program <br />Element: <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 />7. The sharps waste container shall be within arm's reach and labeled with the word "sharps waste" or with the biohazard symbol <br />and the word "Biohazard". Sharp waste containers shall be disposed by a licensed waste hauler or approved mail back system. <br />Documentation of proper disposal shall be maintained for 3 years. HSC 119314(e) <br />11. The procedure area shall be equipped with a sink with hot and cold running water, containerized liquid soap, and single use <br />paper towels dispensed from a wall -mounted, touchless dispenser that is readily accessible to practitioner. HSC 119314(b) <br />14. Practitioner shall put on appropriate personal protective equipment, including gloves, aprons, lap pads, etc. Gloves shall be <br />worn throughout the procedure. HSC 119308(a) <br />18. The facilities client consent form and medical questionnaire must include ali of the information listed in Form B, and are <br />available for inspection. HSC 119303 <br />19. At the completion of the procedure, the practitioner shall provide postprocedure instructions that include all elements listed in <br />Form B. HSC 119308(b) <br />24. Disinfectant shall have ability to reduce or eliminate the presence of disease -causing microorganisms, including HIV and <br />hepatitis B virus. HSC 119301(k) <br />26. Any part of a tattooing machine that may touch the practitioner during procedure shall be covered with a disposable plastic <br />sheath. HSC 119311(h) <br />28. Sterilized instrument packs, equipment and jewelry shall be stored in a labeled container or cabinet that is protected from <br />dust or moisture. Sterile instrument packs shall be evaluated before use; instrument packs shall be discarded or reprocessed if <br />condition is compromised. HSC 119315 <br />Reinspecion on/about: A reinspection fee of $125 per hour may charged. Page 2 of 3 <br />EH -04/2014 <br />