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ot*qut^!. c <br />Body Art Inspection Report Date: <br />San Joaquin County Environmental Health Department Program <br />1868 E. Hazelton Ave., Stockton, CA 95205 Record: <br />(209) 468-3420 <br />www.sioay.org/ehd Program <br />FlamanY <br />PR Number <br />PRACTITIONER/ARTIST NAME <br />PR0537458 <br />Gustavo Hurtado (BBP exp. <br />6/15/23 <br />PR0548026 <br />Andre Becerra (BBP exp. <br />10/18/23 <br />PR0547879 <br />AnthonyMontes (BBP exp. <br />6/2/23 <br />PR0548328 <br />Michael Adkins (BBP exp. <br />3/16/24 <br />Observations and Corrective Actions: <br />March 22, 2023 <br />P RO540884 <br />412x) <br />PR Number <br />PRACTITIONER/ARTIST NAME <br />PR0547361 <br />Michael Hardman (BBP exp. 12/10/23 <br />PR0548263 <br />Francisco Huaracha Arevalo (BBP exp. 2/11/24 <br />PR0548328 <br />Rosemarie Serrano (BBP exp. 3/14/24 <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) —A sterilization certificate was not available for Gustavo Hurtado's Quelle <br />needle cartridges with the lot # 2021/12 and for Michael Adkins' XXX needle cartridges with the lot # 21-07. Provide <br />EHD with sterilization certificates for the needle cartridges mentioned. <br />9. No food, drink, tobacco product, or personal effects are permitted in the procedure area. HSC 119309 — An open red bull <br />can with liquid was observed in Michael Adkins' procedure area. Remove the beverage from the procedure area and <br />provide photographic evidence to the EHD. <br />18. The facility's client consent form and medical questionnaire must include all of the information listed in Form B, and are <br />available for inspection. HSC 119303 — Three years of client records were not available for review. Ensure client <br />records for ALL practitioners are at the facility and available for review. <br />18. The facility's client consent form and medical questionnaire must include all of the information listed in Form B, and are <br />available for inspection. HSC 119303 Gustavo Hurtado's client records did not include the lot numbers of the needles <br />used. Ensure the lot numbers of needle cartridges are written or attached to all client records. <br />18. The facility's client consent form and medical questionnaire must include all of the information listed in Form B, and are <br />available for inspection. HSC 119303 — Michael Adkins' client records did not have the clients' photo IDs, the client <br />signatures or the information of the needle cartridges used (lot #). Ensure all information is complete on the client <br />records and picture IDs of the clients are attached. <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 — The medical questionnaire did not include all of the information listed on Form <br />B. Include the following information and provide a copy to the EHD: <br />- Client status regarding pregnancy. <br />- History of herpes infection at the procedure site. <br />- History of diabetes. <br />- Current medications. <br />25. Disinfectant shall be used according to the manufacturer's instructions. HSC 119309(b) —The wet contact time <br />provided for the Madacide was 5 minutes. The instructions on the bottle stated the wet contact time is 6 minutes. <br />Ensure the manufacturer's instructions are followed. <br />32. A body art facility shall have floors, walls, and ceilings that are smooth, nonabsorbent, free of open holes, and washable. <br />The body art facility shall be free of insect and rodent infestation. The procedure area must be separated, by a wall, ceiling to <br />floor, from nail and hair activities and be separated from all business not related to body art. Approval of co -located body art <br />facilities are at the discretion of the LEA. A procedure area must be equipped with adequate light to perform a procedure. Each <br />procedure area shall have lined waste containers. HSC 119314 & 119317 —The holes on the front of the shop were <br />recently patched, but the paint used was not easily washable. There are holes on the wall of Andre Becerra's <br />procedure area. The area around the baseboard of Michael Adkins procedure area is in need of repair. Repair, patch <br />and paint all areas mentioned and provide EHD with photo graphic evidence. <br />Reinspection on/about: A reinspection fee of $156 per hour may be charged. Page 2 of 3 <br />EH -11/17 <br />