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2)�p4 M c02 Body Art Inspect Report Date: 6 A <br /> G <br /> y ./i San Joaquin County Environmental Health Department Program <br /> / 1868468-3420 Hazelton Ave.,Stockton,CA 95205 Record: 5Sz p t) 711 3� <br /> P Program (� <br /> www.siogv.org/ehd Element: <br /> Facility Name Address City Zip Code <br /> Shanmarie 233 dorris place Stockton 95204 <br /> Name of Permit/Registration Holder Permit Exp. Date Time In Time Out Inspection Type <br /> Shannon Meder Final Consult. <br /> The above facility is inspected for compliance with Division 104,Part 15,Chapter 7 of California Health and Safety Code(HSC). <br /> V=Violation C=Corrected On Site <br /> ❑ 1 Autoclave:approved and effective-passed integrator ❑ ❑ 22. Parts replaced between clients-grommets,elastic bands, Eltestetc. <br /> Items washed,disinfected,packaged,labeled,and <br /> El 2' sterilized El <br /> ❑ 3. Autoclave loaded correctly/packages allowed to dry ❑ ❑ 23. Workstation/procedure area decontaminated ❑ <br /> ❑ 4. Integrators used/monthly spore test/log maintained ❑ ❑ 24. Appropriate chemical disinfectant used <br /> Decontamination/sanitation area separated and supplied ❑ <br /> ❑ 5' E] Chemical used: Cavicide <br /> appropriately <br /> El 6. <br /> ro riatel <br /> Invoices and log kept for disposable, pre-sterilized <br /> El 6' El El 25. Disinfectant used appropriately/sufficient contact time <br /> equipment <br /> ElSharps containers labeled, used,and disposed of <br /> El 7' E] Wet contact time provided: 3 mins <br /> appropriately <br /> E:i 8. <br /> ro riatel <br /> Jewelry,tattoo and piercing equipment-clean and <br /> ❑ 8' sterilized ❑ ❑ 26. Barriers used ❑ <br /> Products applied to skin are single use/dispensed <br /> a El 27. El <br /> ❑ 9. No eating,drinking or smoking-clean clothes ❑ ❑ 28. Storage of inks,pigments, needles,tubes,etc. ❑ <br /> ❑ 10. Hands washed effectively and timely ❑ ❑ 29. Jewelry, Inks, Needles etc approved and used correctly ❑ <br /> Handwashing facilities properly supplied and accessible, Cross-contamination avoided during all phases of <br /> [j 11. ❑warm water ❑ 30. procedure <br /> El <br /> ❑ 12. Hepatitis B vaccination ❑ <br /> ❑ 13. Bloodborne Pathogen trainingE] ElEl31. Areas separated/no living or sleeping quarters <br /> Source: Body Art Training Group ❑ 32. Floors and walls clean and in good repair,adequate light ❑ <br /> Appropriate personal protective equipment available and Workstation,surfaces, including chairs,armrests,etc. in <br /> ❑ 14. used El ❑ 33' ood repair <br /> El <br /> ❑ 34. Permit/registration posted ❑ <br /> Branding is completed with no other customers in <br /> El 15. E] El 35. Operation and employee training records present <br /> procedure area <br /> ❑ 16. Customers eighteen(18)years of age or older ❑ <br /> ❑ 17. Skin adequately prepared for procedure ❑ 7r_1 36. Plan(s)submitted for review E]Client records approved and available-Consent form <br /> ® 18. and uestionnaire El El 37. Permits obtained and available El <br /> ❑ 19. Appropriate aftercare instructions given to client ❑ 38. Impoundment ❑ <br /> Nt AIOF El39. Hearing scheduled ❑ <br /> +, <br /> 7[01 20. Safe machine design El El40. Closure El 21. Machines cleaned and disinfected between clients ❑ ❑ 41. ❑ <br /> Received b (Print): Shannon Meder Received by(Signature): �,�e� Phone: 209 466-8100 <br /> Specialist(Print): Har rit Mattu,Sr REHS Specialist(Signature): Phone: 209 468-3284 <br /> Reinspecion on/about: A reinspection fee of$130 per hour may be charged. Page 1 of 2 <br /> EH-03/2015 <br />