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COMPLIANCE INFO
Environmental Health - Public
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4100 – Safe Body Art
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PR0548004
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COMPLIANCE INFO
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Entry Properties
Last modified
4/27/2026 11:14:46 AM
Creation date
3/5/2024 9:14:00 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4100 – Safe Body Art
File Section
COMPLIANCE INFO
RECORD_ID
PR0548004
PE
4121 - BODY ART FACILITY-STERILIZATION
FACILITY_ID
FA0027381
FACILITY_NAME
LOST DREAMS TATTOOS & PIERCING (CARTER, MICHAEL)
STREET_NUMBER
5920
STREET_NAME
PACIFIC
STREET_TYPE
AVE
City
STOCKTON
Zip
95207
CURRENT_STATUS
Active, billable
QC Status
Approved
Scanner
SJGOV\sballwahn
Supplemental fields
Site Address
5920 PACIFIC AVE STOCKTON 95207
Tags
EHD - Public
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RUIN <br /> Body Art Inspection Report Date: 4/2/2026 <br /> (yZ�I San Joaquin County Environmental Health Department Program <br /> : •� 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: PRO548004 <br /> (209)468-3420 Program <br /> www.siogv.org/ehd <br /> C�FORei% Element: 4121 <br /> R Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> PR0537415 Michael Carter BBP ex 5-30-2026 Cathy Montie PRO540033 Angel U arte BBP ex 4-2-2027 Cathy Montie <br /> PR0648266 Ava Reyes BBP ex 2-6-2026 Cathy Montie PRO537482 Dennis Escalante BBP ex 2-4-207 Cathy Montie <br /> PR0548837 Sonny Jerome Brown BBP ex 6/8/2026 Cathy Montie PR2600073 Exavier Garibay BBP ex 1/30/27 ProBloodborne <br /> PR2500153 I Margret Hodson BBP ex 2-18-2027 Cathy Montie PR0548032 David Javier ex 7-2-2026 Cathy Montie <br /> Observations and Corrective Actions: <br /> 4. HSC 119315 Integrators used/monthly spore test/log maintained. <br /> OBSERVATIONS: <br /> 1.There is a discrepancy in the dates for Load number 126. The binder documents the date as 9/05, while the indicator shows <br /> the date as 9/06. <br /> 2.Tests lacking/not performed for November 2025 for both sterilizers. <br /> CORRECTIVE ACTIONS: <br /> 1.Ensure that documentation is accurate. When documenting the date a test is run, include the year. Alternatively, provide the <br /> year at the top of the log book page. For example, the date entry should read 9/5/24, or the top of the log book page should state <br /> "2024." <br /> 2.Ensure spore test is occuring monthly for both sterilizers. <br /> 6. HSC 119315 Invoices and log kept for disposable, pre-sterilized equipment. <br /> OBSERVATIONS: <br /> Magic Moon needle LOT number W240301 lacks sterilization certificate. Rhein needle Lot number 2025Q1 lacks sterilization <br /> certificate. <br /> CORRECTIVE ACTION: <br /> Provide sterilization certificates for needles. <br /> 7. HSC 119314-Sharps containers labeled, used, and disposed of appropriately. <br /> OBSERVATION: <br /> The biohazard container is labelled "Pathology Waste Incinerate Only" <br /> CORRECTIVE ACTION: <br /> Ensure biohazard container has the correct label. <br /> Provide the EHD with a photo of the biohazard container with proper label. <br /> 13. HSC 119307- Bloodborne Pathogen training. <br /> OBSERVATION: <br /> Ava Nicole Reyes blood borne pathogen certificate expired on 2-6-2026. <br /> CORRECTIVE ACTION: <br /> Provide the EHD with a copy of a current blood borne pathogen certificate from the approved "Providers of Bloodborne <br /> Pathogens Training" <br /> 18. HSC 119303 -Client records approved and available -Consent form and questionnaire <br /> OBSERVATION: <br /> 1. Needle lot numbers are not documented on a few of the completed consent forms. <br /> 2.1 reviewed blank consent forms and all items on Form B are not on consent forms; <br /> Tattoo consent forms lack the following: <br /> -When to seek medical attention <br /> -Signs and symptoms of infection <br /> Reinspection on/about: A reinspection fee of$179 per hour may be charged. Page 2 of 3 <br /> EH-11/17 <br />
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