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Op,O,UIN Q <br /> Body Art Inspection Report Date: April 22,2025 <br /> N j San Joaquin County Environmental Health Department Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: PR0544621 <br /> (209)468-3420 Program <br /> www.sioov.org/ehd Element: 4120 <br /> 18. HSC 119303 -Client records approved and available -Consent form and questionnaire <br /> OBSERATIONS: <br /> 1. Mark Escalante's client records were missing the clients' personal information and some of the tattoo client records were <br /> missing the artists' names. <br /> 2. The tattoo consent form did not have all the information from Form B. <br /> 3. The piercing consent form did not have all the information from Form B. <br /> 4. The tattoo medical questionnaire did not include all the items from Form B. <br /> 5. The piercing medical questionnaire did not include all the items from Form B. <br /> CORRECTIVE ACTIONS: <br /> 1. The facility's client consent form and medical questionnaire must include all the information listed in Form B and are available <br /> for inspection. Ensure all client consent forms are complete. <br /> 2. The facility's client consent form and medical questionnaire must include all the information listed in Form B and are available <br /> for inspection. Include the following on the tattoo consent form and provide a copy to the EHD: <br /> - Description of what the client should expect following the procedure. <br /> 3. The facility's client consent form and medical questionnaire must include all the information listed in Form B and are available <br /> for inspection. Include the following on the piercing consent form and provide a copy to the EHD: <br /> - Statement regarding the permanent nature of the procedure. <br /> 4. The facility's client consent form and medical questionnaire must include all the information listed in Form B and are available <br /> for inspection. Include the following on the tattoo medical questionnaire and provide a copy to the EHD: <br /> - Requirements for antibiotics prior to surgery or dental procedures. <br /> 5. The facility's client consent form and medical questionnaire must include all the information listed in Form B and are available <br /> for inspection. Include the following on the piercing medical questionnaire and provide a copy to the EHD: <br /> - History of herpes infection at the procedure site. <br /> - History of hemophilia or other bleeding disorders. <br /> -Current medications. <br /> 19. HSC 119303, 119308 -Appropriate aftercare instructions given to client <br /> OBSERVATIONS: <br /> Aftercare instructions were not available for tattoo procedures or for piercings. <br /> CORRECTIVE ACTIONS: <br /> At the completion of the procedure, the practitioner shall provide postprocedure instructions that include all elements listed in <br /> Form B. Provide EHD with aftercare instructions for tattoos and piercings. <br /> 29. HSC 119310, 119311 -Jewelry, Inks, Needles etc approved and used correctly <br /> OBSERVATIONS: <br /> Information on the type of material the jewelry is made of was not available. <br /> CORRECTIVE ACTIONS: <br /> Only jewelry made of approved material and commercially manufactured inks, dyes, and pigments shall be used. Provide EHD <br /> with information on the jewelry used on newly pierced skin. <br /> 32. HSC 119314- Floors and walls clean and in good repair, adequate light <br /> OBSERVATIONS: <br /> The baseboard in Mark Escalante's procedure room is scratched/damaged and in need of sealant. <br /> CORRECTIVE ACTIONS: <br /> A body art facility shall have floors, walls, and ceilings that are smooth, nonabsorbent, free of open holes, and washable. Repair/ <br /> replace and seal the baseboards and provide EHD with photographic evidence. <br /> Reinspection on/about: A reinspection fee of$172 per hour may be charged. Page 3 of 4 <br /> EH-11/17 <br />