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u.r`. <br />(Is6 <br />ecc Body Art Inspection Report <br />Date; 12/27/21 <br />San Joaquin County Environmental Health Department Program <br />1868 E. Hazelton Ave., Stockton, CA 95265 Record: PRO546374 <br />(269)468-3420 <br />W .eloOy.orn/ehProgram <br />a� Element: 4120 <br />PR Number <br />PRACTITIONER/ARTIST NAME <br />PR0544308 <br />Marian Chavez BBP exp. 12/5/22 <br />Observations and Corrective Actions: <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 client records did not have the client's photo identification attached or the lot <br />number of the blades used. Ensure a copy of the client's photo ID is attached to the client record and the lot number of <br />the blade is either written or attached to the record. <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) — The postprocedure instructions did not include all the elements listed in Form B. Include the <br />following and provide an updated copy to the EHD: <br />- Signs and symptoms of infection. <br />- Indications when to seek medical care. <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— There is a gap between the baseboard and the <br />floor. Seal all gaps between the baseboard and floor and send photographic evidence to the EHD. <br />Correct all violations and provide evidence of correction to the EHD by <br />January 10, 20220 <br />Notes: <br />1. Inspection report emailed to facility owner, Marian Chavez, at mic4u2008na.vahoo.com. <br />2. The sharps waste was disposed by previous owner, Annie Mehrten. Evidence of sharps disposal is not available. <br />3. Ensure there is no food or drinks in the procedure area and all absorbent items are 5 or more feet from the procedure table/ <br />chair. <br />4. A current Bloodborne Pathogen Training Certificate <br />Relnspectlon <br />EH -11/17 <br />and health permit were posted. <br />A reinspection fee of $152 per hour may be charged. <br />Page 2 of 2 <br />