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Body Art InspectiOReportDate: A <br /> T San Joaquin County Environmental Health Department Program�� Ci <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: <br /> (209)468-3420 <br /> www.siogv.oro/ehd Program uu 12—Element: -IIZ � <br /> PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONERJARTIST NAME <br /> PR0543522 Carmela Chavez-Permit Posted and Current <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)—Provide evidence of sterilization and proof of purchase for the needles <br /> and blades use by the practitioner. <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)—Provide a written agreement or contract <br /> with an approved mail back system.The sharps waste container shall be within arm's reach. <br /> 13. Practitioner shall provide evidence of a completed, EHD approved, OSHA Bloodborne Pathogen Training consistent with <br /> section 119307.—Provide a copy of a current bloodborne pathogen training certificate from an approved source. <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—Medical questionnaire is missing the following requirements.Submit an updated <br /> medical questionnaire to the EHD. <br /> Client consent form must include the lot number and expiration date of the needlelblade use on the client.Also <br /> maintain a copy of the clients' Driver's License with their records. <br /> 1. History of herpes infection at the procedure site <br /> 2. History of allergic reactions to latex <br /> 3. History of allergice reactions to antibiotics <br /> 4. History of diabetes <br /> 5. History of hemophilia or other bleeding disorders <br /> 6. History of cardiac valve disease <br /> 7. Current medications <br /> 8. Requirements for antibiotics prior to surgery or dental procedures <br /> 9. Other risk factors for blood borne pathogens <br /> 27. Products applied to skin prior to tattooing or application of permanent cosmetics, including, but not limited to, stencils, <br /> marking and transfer agents, shall be single use and discarded into a waste container at the end of the procedure. HSC <br /> 119311(a)—All products applied to the skin shall be single use only. <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 /> Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Page 2 of 3 <br /> EH-11/17 <br />