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Body Art Inspection Report Date: November 16, 2021 aSan Joaquin County Environmental Health Department Program 1868 E. Hazelton Ave., Stockton, CA 95205 Record: PRO546020 R. (209)468-3420 P • w .siocv.ora/ehd Program L[r•-vim. Element: 4120 Facility Name Address City Zip Code JB's Ink Therapy 222 N EI Dorado St. #F Stockton 95202 Name of Permit/Registration Holder Permit Exp. Date Time In Time Out Inspection Type Jeston Barnett 6/30/22 Routine The above facility is inspected for compliance with Division 104, Part 15, Chapter 7 of California Health and Safety Code (HSC) 1. Autoclave: approved and effective - passed integrator test V = Violation C = Corrected On Site ❑ ❑ V CLEANING AND STERILIZATION C �2+tGLl� V MACHINE SAFETY AND SANITATION cont. C ® 1. Autoclave: approved and effective - passed integrator test ❑ ❑ 22. Parts replaced between clients - grommets, elastic bands, etc. ❑ ❑ 2 Items washed, disinfected, packaged, labeled, and sterilized ❑ PREVENTING CROSS -CONTAMINATION ® 3. Autoclave loaded correctly/packages allowed to dry ❑ ❑ 23. Workstation/procedure area decontaminated ❑ ® 4. Integrators used/monthly spore test/log maintained ❑ ❑ 24. Appropriate chemical disinfectant used ❑ ® 5 Decontamination/sanitation area separated and supplied appropriately ❑ Chemical used: ® 6 Invoices and log kept for disposable, pre -sterilized equipment ❑ ❑ 25. Disinfectant used appropriately/sufficient contact time El7 ❑ Sharps containers labeled, used, and disposed of appropriately ❑Wet contact time provided: ❑ 8 Jewelry, tattoo and piercing equipment - clean and sterilized El El26. Barriers used El PRACTITIONER HEALTH AND HYGIENE ❑ 27. Products applied to skin are single use/dispensed aseptically ❑ ® 9. No eating, drinking or smoking - clean clothes ❑ ❑ 28. Storage of inks, pigments, needles, tubes, etc. ❑ ❑ 10. Hands washed effectively and. timely ❑ ❑ 29. Jewelry, Inks, Needles etc approved and used correctly ❑ ® 11 Handwashing facilities properly supplied and accessible, warm water ❑ ❑ 30. Cross -contamination avoided during all phases of procedure ❑ ❑ 12. Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES ® 13, Bloodborne Pathogen training ❑ ❑ 31. Areas separated/no living or sleeping quarters ❑ Source: ® 32. Floors and walls clean and in good repair, adequate light ❑ ❑ 14. Appropriate personal protective equipment available and used ❑ ❑ 33' surfaces, including chairs, armrests, etc. in good repair ElWorkstation, CUSTOMERSICLIENTS ❑ 34. Permil/registration posted ❑ ❑ 15 Branding is completed with no other customers in rocedure area El ® 35. Operation and employee training records present El ❑ 16. Customers eighteen (18) years of age or older ❑ COMPLIANCE AND ENFORCEMENT ❑ 17. Skin adequately prepared for procedure ❑ ® 36. Plants) submitted for review ❑ ® 18 Client records approved and available - Consent form and ❑ ❑ 37, Permits obtained and available El ® 19. Appropriate aftercare instructions given to client ❑ ❑ 38. Impoundment ❑ MACHINE SAFETY AND SANITATION ❑ 39. Hearing scheduled ❑ ❑ 20. Safe machine design ❑ ❑ 40. Closure ❑ ❑ 21. Machines cleaned and disinfected between clients ❑ ❑ 41. ❑ Received by (Print): Jeston Barnett Received by (Signature): Emailed Phone301-462-9784 one: Specialist (Print)' Sandip Singh Specialist (Si nature)' �2+tGLl� �iit9%G