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4100 – Safe Body Art
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PR0537419
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COMPLIANCE INFO
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Last modified
6/7/2023 4:27:25 PM
Creation date
5/12/2023 2:19:18 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4100 – Safe Body Art
File Section
COMPLIANCE INFO
RECORD_ID
PR0537419
PE
4110
FACILITY_ID
FA0024304
FACILITY_NAME
GYPSY SOUL TATTOO (HOLGUIN, JOHN)
STREET_NUMBER
118
Direction
W
STREET_NAME
YOSEMITE
STREET_TYPE
AVE
City
MANTECA
Zip
95336
CURRENT_STATUS
02
SITE_LOCATION
118 W YOSEMITE AVE
P_LOCATION
04
QC Status
Approved
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EHD - Public
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;oP4w' <br />Body Art Inspect Report <br />Date: <br />San Joaquin County Environmental Health Department <br />Program <br />p <br />1868 E. Hazelton Ave., Stockton, CA 95205 <br />Record: <br />Y. <br />egt/FORa`P <br />(209) 468-3420 <br />Program <br />V <br />LA U�3 <br />wwwsiogv.org/ehd <br />Element: <br />NAME <br />PR Number <br />PR0537419 <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 />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. 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 />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 />facilites are at the discretion of the LEA. A rocedure area must be equipped with adequate light to perform a procedure. Each <br />procedurirea shall have ers. HSC 119314 & 119317 <br />34. Certificate of registration and health permit shall be posted in a conspicuous place. HSC 119306 and 119312 <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 />All of the abo, <br />a final consul <br />mentioned obsery <br />ns must be co <br />on must be conducted, and all applicable <br />fees must be paid prior to opening. <br />Reinspecion on/about: A reinspection fee of $130 per hour may be charged. Page 2 of 2 <br />EH -03/2015 <br />
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