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Body Art Inspean Report Is Date: -7AR-1i$ <br /> y San Joaquin County Environmental Health Department Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: I IQ,W PP_ <br /> (209)468-3420 Program <br /> c+`P, www.siogv.org/ehd Element: Y1 <br /> �/Fps <br /> PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> Otilia Aguila: BBP available <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)-Submit certificate of sterilization received from manufacturer(can obtain <br /> on Tina Davies'website). <br /> 16. Client shall be at least 18 years of age to receive a tattoo, permanent cosmetics, or branding. Body piercing, unless <br /> performed in the presence of parent or guardian, the client, must be 18 years of age. HSC 119302-Include in consent form: <br /> client is at least 18 years of age. Provide copy of client's driver's license/identification with client records. <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-Include in consent form: statement regarding permanent nature of procedure,and <br /> notice that inks are not FDA approved and health consequences are unknown. Complete all required items in medical <br /> questionnaire. <br /> 19. At the completion of the procedure, the practitioner shall provide postprocedure instructions that include all elements listed it <br /> Form B. HSC 119308(b)-Include in postprocedure instructions: signs and symptoms of infection and indications when <br /> to seek medical care. <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 /> Notes: <br /> 1) One year exemption is given for installing handwashing sink in procedure area. Install a handwashing sink, <br /> equipped with hot and cold running water, in the procedure area by July 1, 2019 in order to proceed with <br /> operations. <br /> 2) Room must remain open during operations. No work may be conducted with procedure area closed off from <br /> access to handwashing sink. <br /> 3) Upon receipt, post permit in a conspicuous place. <br /> Correct all violations by July 16 2018. Facility is approved for operations,contingent upon procedure area <br /> remaining open during operations Handwashina sink shall be installed in procedure area by July 1 2019. <br /> Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Page 2 of <br /> EH-11/17 <br />