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onw�' Body Art Inspection Report Date(MM/DDNY) -L County of San Joaquin County,Environmental Health Department 1868 E.Hazelton Ave.,Stockton CA 95205 Permit Number (209)468-3420 www.sigov.org/ehdPermit Type Facility Name Address City Zip Code CT Tfu93'1 to Son f o 1A, n Pet/Registration Alder Name Permit Exp.Date Total Time ln&pection Type`s 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/0=Not Observed N/A=Not Applicable COS=Corrected On Site TATTOO AN , �....a .. E E CLEANING AND STERILIZATION , ft,.: r, our cos SAFETY AN A 0: our cos In 1. Autoclave is approved and effective-passed ❑ ❑ N/0 18. Safe machine design ❑ ❑ N/ integrator test N/A 0 2. Process of cleaning,labeling,packaging and ❑ ❑ In N10 19, Machines cleaned and disinfected between ❑ ❑ N/ sterliziin items correctly / clients In 0 3. Autoclave loaded correctly/packages allowed to ❑ ❑ In l 20. Parts replaced between clients-grommets, ❑ ❑ N/ d elastic bands,etc. In 10 4. Integrators used/monthly spore test/log ❑ ❑ "10 ,801 TA IU TION W" 0 19 N/ maintained In NIO 5. Decontamination/sanitation area separate and ❑ ❑ I N/0 21. Workstation/procedure area decontaminated ❑ ❑ ! supplied* N/A In N/0 6. Invoices and log kept for disposable,pre- N ❑ I N/0 22. Chemical disinfectant used ❑ ❑ N/A sterilized equipment,backupsupplies available* N/ Chemical used:li t -IYAt1661 In NIO 7. Sharps containers supplied,labeled,used and ❑ In /0 23. Disinfectant used sufficient contact time Wet ❑ ❑ N/A disposed of correctly* N contact time provided: Irl N/O 8. Jewelry,tattoo and piercing equipment-storage ❑ ❑ In NIO 24. Barriers available and used as part of ❑ ❑ N/A and use N/A procedure 1 N/0 25. Products applied to skin are single PRA ❑ ❑ NIA use/dispensed ensed ase tical) In N/O 9. No eating,drinking or smoking-clean clothes ❑ ❑ In N10 26. Storage of inks,pigments,needles,tubes,etc., ❑ ❑ N/A NIA [a NiO 10. Hands washed effectively and timely ❑ ❑ In N/0 27. Jewelry,Inks,Needles etc approved and used ❑ ❑ NIA /A In WO 11. Handwashing facilities properly supplied andIn N/0 28. Cross-contamination avoided during all phases ❑ 13/A accessible,warm table water* '� ❑ NIA ofprocedure In N/0 12. Personal protective equipment available and NIA used,eyewash station available" ❑ ❑ y G_USTOMERSICLIENTS .w: In WO 29. Areas separated/no living or sleeping ❑ ❑ N/Aquarters/no animals In 13. Branding is completed with no other customers in ❑ ❑ In N/0 30. Floors and walls clean and in good repair, ❑ ❑ N/A procedure area N/A ade uate ii ht I N/0 14. Customers eighteen(18)years of age or older In N/0 31. Workstation,surfaces,including chairs,,etc.in N/A ❑ ❑ N/A good repair;trash removed frequently* ❑ ❑ I N/0 15. Skin prepared for procedure. ❑ ❑ In N/0 32. Permit/registration and required signs posted* ❑ N/A N/A In N/0 16. Client records available-Consent form& ❑ In N/0 33. IPCP and employee training records and '110i El NIA questionnaire N/A He atitiis B vaccination status resent In N/0 17. Aftercare instructions given to client ❑ N/0 34 Restrooms available,stocked* ❑ ❑ N/A N/A Received b Print: h,Lk QmA&eceivPhone: Loq `fc"7 tea' 9,7 S ecialist(Print): .n IG S tDkn Specialist(Signa ure: Phone(i 0 -J)9 g This report is an Official Notice of Violation.Corrections must be completed in the time specified. A reinspection fee maybe charged if violations noted on this report are not corrected by the reinspection date. Reinspection Date(on or about) Page I-of 3