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COMPLIANCE INFO
Environmental Health - Public
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EHD Program Facility Records by Street Name
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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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io. ui— c <br /> Body Art Inspection Report Date: July 10,2024 <br /> W2 Z�1 San Joaquin County Environmental Health Department Program <br /> i 1868 E.Hazelton Ave.,Stockton,CA 95205 <br /> Record: PR0548004 <br /> (209)46e-3420 <br /> Program <br /> \c4�rFoaip www.sioay.ora/ehd Element: 4121 <br /> PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> PR0537415 Michael Carter BBP Exp.9/18/24 PR0548837 Sonny"Jerome"Brown(BBP Exp.8/14/24 <br /> PR0548266 Ava Reyes BBP Exp. 1/30/25 PRO548032 David Javier(BBP Exp. 1/17/25 <br /> Observations and Corrective Actions: <br /> 4. HSC 119315-Integrators used/monthly spore test/log maintained <br /> OBSERVATIONS: <br /> Spore test results were provided from May 2023 to June 2024. Facility owner did not provide results from October 2022. <br /> CORRECTIVE ACTIONS: <br /> Sterilizer shall be spore-tested after initial installation, after major repair, and at least once per month. A written sterilization shall <br /> be maintained for 3 years. The log shall include spore-test results each sterilization cycle, date, contents, exposure time and <br /> temperature, results of the Class V integrator for every cycle/load, and evidence of an acceptable spore test before reuse of the <br /> sterilizer after a failed spore-test. Provide EHD with spore test results from October 2022 to April 2023. <br /> 9. HSC 119309-No eating, drinking or smoking -clean clothes <br /> OBSERVATIONS: <br /> A tumbler was observed on Sonny"Jerome" Brown's work station. —Corrected on site <br /> CORRECTIVE ACTIONS: <br /> No food, drink, tobacco product, or personal effects are permitted in the procedure area. <br /> 18. HSC 119303 -Client records approved and available-Consent form and questionnaire <br /> OBSERVATIONS: <br /> 1. The tattoo medical questionnaire did not include all items from Form B. <br /> 2. The piercing medical questionnaire did not include all items from Form B. <br /> 3. Client records were missing client IDs, identification for minors (piercing only), lot numbers of needles, client signatures and <br /> the procedure(s)were not recorded. <br /> CORRECTIVE ACTIONS: <br /> 1. The facility's client consent form and medical questionnaire must include all of the information listed in Form B, and are <br /> available 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 /> 2. The facilities client consent form and medical questionnaire must include all of the information listed in Form B, and are <br /> available for inspection. Include the following on the piercing medical questionnaire and provide a copy to the EHD: <br /> -Current medications <br /> 3. The facilities client consent form and medical questionnaire must include all of the information listed in Form B, and are <br /> available for inspection. Ensure all client records are complete. <br /> 19. HSC 119303, 119308 -Appropriate aftercare instructions given to client <br /> OBSERVATIONS: <br /> The tattoo aftercare instructions did not contain all of the elements from Form B. <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. Include the following on the tattoo aftercare instructions and provide a copy to the EHD: <br /> - Restrictions on physical activities. <br /> -Signs and symptoms of infection. <br /> Reinspection on/about: A reinspection fee of$172 per hour may be charged. Page 2 of 4 <br /> EH-11/17 <br />
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