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zt , <br /> Body Art Inspect Report Date: walls <br /> Na San Joaquin County Environmental Health Department Program U <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: PRO S I S 3q I. <br /> Program <br /> V110"' <br /> (209)468-3420 Pro9 a <br /> WWW.sogyAfq/ehd 111 <br /> Element: 1 I C <br /> Facility Name Address City Zip Code <br /> 12 Monkeys Tattoo Studio 911 central ave. Tracy 95376 <br /> Name of Permit/Registration Holder Permit Exp.Date Time In Time Out Inspection Type <br /> Jon Highland 6/30/15 Routine <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 /> V CLEANING AND STERILIZATION C V MACHINE SAFETY AND SANITATION(cont.) C <br /> ❑ 1 Autoclave:approved and effective-passed integrator ❑ El22 Parts replaced between clients-grommets,elastic bands, F1test etc. <br /> ❑ 2 Items washed,disinfected,packaged,labeled,and <br /> sterilized PREVENTING CROSS-CONTAMINATION <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 /> ❑ 5 Decontamination/sanitation area separated and supplied Elappropriately <br /> El Chemical used: <br /> ® 6 Invoices and log kept for disposable,pre-sterilized <br /> equipment ❑ E] 25. Disinfectant used appropriately/sufficient contact time <br /> ❑ El7 Sharps containers labeled,used,and disposed of <br /> ElWet contact time provided: <br /> appropriately <br /> ❑ 8 Jewelry,tattoo and piercing equipment-clean and <br /> ❑ El 26. Barriers used Elsterilized <br /> ❑ 27 Products applied to skin are single use/dispensed ❑ <br /> PRACTITIONER HEALTH AND HYGIENE aseptically <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 /> ® 11. Handwashing facilities properly supplied and accessible, Cross-contamination avoided during all phases of ❑ <br /> warm water El ❑ 30' procedure <br /> ❑ 12. Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES <br /> ❑ 13. Bloodborne Pathogen training ❑ ❑ 31. Areas separated/no living or sleeping quarters ❑ <br /> Source: ❑ 32. Floors and walls clean and in good repair,adequate light ❑ <br /> ❑ 14. Appropriate personal protective equipment available and El ❑ Workstation,surfaces, including chairs,armrests,etc.in <br /> used 33' El repair <br /> CUSTOMERS/CLIENTS ® 34. Permit/registration posted ❑ <br /> ❑ 15 Branding is completed with no other customers in <br /> rocedure area ElEl35. Operation and employee training records present El <br /> ❑ 16. Customers eighteen(18)years of age or older ❑ COMPLIANCE AND ENFORCEMENT <br /> ❑ 17. Skin adequately prepared for procedure ❑ ❑ 36. Plan(s)submitted for review ❑ <br /> ® 18 Client records approved and available-Consent form <br /> and El El 37. Permits obtained and available ❑ <br /> uestionnaire <br /> ❑ 19. 1 Appropriate aftercare instructions given to client ❑ ❑ 38. Impoundment ❑ <br /> MACHINE SAFETY AND SANITATION ❑ 39. Hearing scheduled ❑ <br /> ❑ 20. Safe machine design ❑ ❑ 40. Closure ❑ <br /> El 21. Machines cleaned and disinfected between clients F-1 ❑ 41. ❑ <br /> Received b (Print): Jon Highland Received b Si na one: 209 839-1265 <br /> Specialist(Print): Benjamin Escotto Specialist Si nature: Phone: 209 468-3178 <br /> GQ <br /> Reinspecion on/about: A reinspection fee of$125 per hour may charged. Page 1 of 2 <br /> EH-04/2014 <br />