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Body Art Inspection Report <br /> / Date: February 10,2028 <br /> r< `s San Joaquin County Environmental Health Department Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: PR2500286 <br /> P/ (209)468-3420 Program <br /> v sioovmm/ehd <br /> �crFogN! Element: 4120 <br /> PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> PRO547836 Fabian Chaves(BBP Ex 7/31/26 <br /> Observations and Corrective Actions: <br /> 18. HSC 119303-Client records approved and available-Consent form and questionnaire <br /> OBSERVATIONS: <br /> 1. Client photo IDs were not attached to the client records. Practitioner added a section to the consent for where the photo ID will <br /> be attached. -CORRECTED <br /> 2. The medical questionnaire did not include all items from Form B. -CORRECTED <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. Ensure the client's photo ID is attached to the record. <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. <br /> 25.HSC 119309-Disinfectant used appropriately/sufficient contact time <br /> OBSERVATIONS: <br /> The wet contact time given for the Madacide was 5 to 7 minutes.The label on the bottle indicates that the wet contact time for <br /> the product is 6 minutes. <br /> CORRECTIVE ACTIONS: <br /> Disinfectant shall be used according to the manufacturer's instructions. Ensure product is left on for approximately 6 minutes. <br /> 31. HSC 119314-Areas separated/no living or sleeping quarters <br /> OBSERVATIONS: <br /> The women's restroom did not have paper towels in the dispenser. <br /> CORRECTIVE ACTIONS: <br /> The toilet facility must have a sink with hot and cold water, containerized liquid soap, and single-use paper towels that are <br /> dispensed from a wall-mounted, touchless dispenser. Restock the paper towel dispenser with paper towels and provide <br /> photographic evidence of correction to the EHD. <br /> Correct all violations and provide evidence of corrections to the <br /> EHD by February 24, 2026. <br /> Relnspection onlabout: A reinspection fee of$179 per hour may be charged. Page 2 of 3 <br /> EH-7-1-25 <br />