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a Body Art InspectioReport Date: __2 l / <br /> San Joaquin County Environmental Health Department Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: <br /> : (209)468-3420 <br /> 'ter •..--t+`' www.sjogv.org/ehd Program <br /> Element: <br /> PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> PRO537458 Gustavo Hurtado-BBP available,permit not <br /> Stephen Adkins(San Jo Sleepz)-Permit given,BBP <br /> PRO542500 posted <br /> PRO542492 I Armando Perez-Permit given,BBP available <br /> PRO537993 Ruben Benites-Permit held,BBP a (1 ear) <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 /> 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. Requirements apply <br /> to restroom as well. HSC 119314(b) <br /> 13. Practitioner shall provide evidence of a completed, EHD approved, OSHA Bloodborne Pathogen Training consistent with <br /> section 119307. <br /> 18. The facilities client consent form and medical questionnaire must include all 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 /> 30. The practitioner shall wear disposable gloves on both hands when touching, decontaminating, or handling a soiled object, <br /> instruments,jewelry or cleaning surfaces in the procedure, decontamination and sterilization areas. The surfaces and objects in <br /> the procedure area shall be disinfected before performing body art in that area. Inks, pigments, soaps, and other products in <br /> multiple-use containers shall be dispensed in a manner to prevent contamination of the storage container through the use of a <br /> single-use receptacle. Distilled water must be used during transfer of inks. HSC 119309 <br /> 35. Operation and employee training records shall be maintained for 3 years and made available for inspection. A written <br /> Infection Prevention and Control Plan (IPCP) shall be maintained, followed and updated. HSC 119313 <br /> 36. Design plans shall be submitted to EHD for approval prior to constructing or remodeling body art facility. HSC 119312 <br /> All violations must be corrected by April 2, 2018. A re-inspection fee of$152 will be charged. <br /> Notes: 1.) Facility has moved to 127 Harding Way Ste A. Entrance is now on Harding way. <br /> Reinspecion on/about: A reinspection fee of$130 per hour may be charged. Page 2 of 2 <br /> EH-03/2015 <br />