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113 ou. Date(MM/DD/YY) /o/r•-- ..co Body Art Inspection Report l County of San Joaquin County,Environmental Health Department pZOSl �� a Permit Number 1ja < 1868 E.Hazelton Ave.,Stockton CA 95205 (209)4683420 www.sioov.org/ehd Permit Type <<FO Facility Name ? Add s City Zip Code CT t21'nt� 1� �� n ) ,re. gS37 Su j0(A i Permit/Registration older Name Permit Exp.Date Total Time Inspection Type �o ) LAS l&n RISK FACTORS AND INTERVENTIONS Risk factors are improper practices or procedures identified as contributing factors of cross-contamination. Interventions are control measures to prevent cross-contamination and transfer of pathogens from one person to another. In=In Compliance Out=Not in Compliance N/O=Not Observed N/A=Not Applicable COS=Corrected On Site 77- TATT001D PERMANENT COSMETICS MACHINE a ,'+,fa. ,�. ,wr ,,.* CLEANING dND.STERILI ATION', � � r�1w,_'ovr cos >��• ,t`u SAFETY,ANDSANITATION�,,;.� ouri�cos I 0 1. Autoclave is approved and effective-passed ❑ ❑ N/O 18. Safe machine design ❑ ❑ N integrator test 1A In 0 2. Process of cleaning,labeling,packaging and ❑ ❑ I /0 19. Machines cleaned and disinfected between ❑ ❑ N/ sterlifling items correctly N/ clients In 3. Autoclave loaded correctly/packages allowed to ❑ ❑ In !0 20. Parts replaced between clients-grommets, ❑ ❑ N/A dry elastic bands,etc. 1 4. Integrators used/monthly spore testflog t PRE ENTING CROSS CONTAMINATION4, z N/A maintained I 5. Decontamination/sanitation area separate and In N/O 21. Workstation/procedure area decontaminated N/A" supplied* ❑ N/A ❑ ❑ In 6. Invoices and log kept for disposable,pre- El In NIO 22. Chemical disinfectantgsed� 11 N/A sterilized equipment,backupsupplies available* /A Chemical used: t''�Giae. In O 7. Sharps containers supplied,labeled,used and ❑ In NIO 23. Disinfectant used sufficient contact time Wet ❑ ❑ /A disposed of correctlyN/A contact time provided: N/0 8. Jewelry,tattoo and piercing equipment-storage 11 /0 24. Barriers available and used as part of 11 El N/A and use /A procedure in /0 25. Products applied to skin are single El 11 PRACTITIONER HEALTH ANY HYGIENE. /A use/dispensed aseptically In 0 9. No eating,drinking or smoking-clean clothes ❑ ❑ In /0 26. Storage of inks,pigments,needles,tubes,etc., 11 ❑ N/A A In /0 10. Hands washed effectively and timely ❑ ❑ In /0 27. Jewelry,Inks,Needles etc approved and used ❑ ❑ N/A /A In N/0 11. Handwashing facilities properly supplied and In N/0 28. Cross-contamination avoided during all phases NIA accessible,warm potable water* NIA of procedure ❑ JI N/O 12. Personal protective equipment available and ti , ri BESTtBUSINE$S PRACTICES* _ `' N/A used,eyewash station available* ❑ �` ' CUS OME 'SICLIE C 2. In N/0 29. Areas separated/no living or sleeping a f �4 xs "� . Q 4'e ..t . ws NIA quarters/no animals* ❑ ❑ In 10 13. Branding is completed with no other customers in ❑ ❑ In 10 30. Floors and walls clean and in good repair, ❑ ❑ /A procedure area /A adequate light* N/0 14. Customers eighteen(18)years of age or older ❑ ❑ In N/O 31. Workstation,surfaces,including chairs,,etc.in ❑ N/A /A good repair;trash removed fre uentl * In /O 15. Skin prepared for procedure. In 0 32. Permit/r�9istration and required signs posted* El I N/0 16. Client records available-Consent form& !E01 ❑ In N/0 33. IPCP and employee training records and El NIA questionnaire N/A Hepatitis B vaccination status present UIn N/0 17. Aftercare instructions given to client In N/0 34 Restrooms available,stocked N/A I 1 ❑ 1 0 1 1 N/A ❑ Received by(Print): -.ice 3 Received by(Signature): Phone: Specialist(Print): Specialist(Signature): Phone: F1This report is an Official Notice of Violation.Corrections must be completed in the time specified. A reinspection fee may be charged if violations noted on this report are not corrected by the reinspection date. Reinspection Date(on or about) Paget of 3