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0 ,o qul ro Body Art Inspection Report Date(MM/DDNY) e-,/ y County of San Joaquin County,Environmental Health Department <� 1868 E.Hazefton Ave.,Stockton CA 95205 Permit Number josh (209)468-3420 www.sigov.org/ehd Permit Type Facility Name Address City Zip Code CT At t lAi�rx>k �-e r�►'�� !I 5y �� w bty � /,-r_ A moi+A tzx �,t�'1 �tty Permit/Registration Holder Name Permit Exp.Date Total Time Inspection Type a.,.4,Z, t A4M_f0^C__ 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 3 .;,._... _ 115 T 4-0 :� COSMETIGSMAGHINE . nF CLEANING AND STERILIZATION . _F�4 _.,. .� g AFEt� SA ATIONour.:cos In N _UQ 1. Autoclave is approved and effective-passed ❑ 0 n WO 18. Safe machine design 0 0 A j integrator test I L,,K/A In JO 2. Process of cleaning,labeling,packaging and O 0 nNJO 19. Machines cleaned and disinfected between 1 0 J stediziing items correct) NIA clients In N/O 3. Autoclave loaded correctly/packages allowed to EI n NJO 20. Parts replaced between clients-grommets, 0 ❑ tiff J� dry NIA elastic bands,etc. In N/O 4. Integrators used/monthly spore tesfflog � � � PREVENTING CROSS-CONTAMINATION . . op maintained In0 5. Decontamination/sanitation area separate and n /0 21. Workstation/procedure area decontaminated A. 13 11 JA ) supplied NIA lr_NIO 6. Invoices and log kept for disposable,pre- Ilb ❑ /11�)N/0 22. Chemical disinfectant used ❑ 11NJA sterilized equipment,backu supplies available* NJA Chemical used: Uta i --�,, In N/O 7. Sharps containers supplied,labeled,used and N/0 23. Disinfectant used sufficient contact time Wet N/A disposed of correctly* JA contact time rovided: .�l n NIO 8. Jewelry,tattoo and piercing equipment-storage N/O 24. Barriers available and used as part of ❑ 11 N/A and use lA procedure* n N/0 25. Products applied to skin are single El 13 PRACTITIONER HEALTH AND HYGIENE N/A use/dispensed aseptically N/0 9. No eating,drinking or smoking-clean clothes 0 El NIO 26. Storage of inks,pigments,needles,tubes,etc., N/A NIA n N/0 10. Hands washed effectively and timely 11 El In N/O 27. Jewelry,Inks,Needles etc approved and used JA IA IIII&A10 11. Handwashing facilities properly supplied and 0 1 n NIO 28. Cross-contamination avoided during all phases 13 El N/A accessible,warm potable water* NIA of procedure On NIO 12. Personal protective equipment available and � � TTMM597 BEST BUSINESS N/A used,eyewash station available CUSTOMERSIGLIENTS 29. Areas separated/no living or sleeping NJquarters/no animals In N/O 13. Branding is completed with no other customers in n NJO 30. Floors and walls clean and in good repair, El 11 J procedure area NJA adequate li ht* n NIO 14. Customers eighteen(18)years of age or olderNJO 31. Workstation,surfaces,including chairs,,etc.in l7 N/A /A good repair;trash removed frequently In' NIO 15. Skin prepared for procedure. /O 32. PermiUregistration and required signs posted NIA jil In N/O 16. Client records available-Consent form& In N/0 33. IPCP and employee training records and 0 0 NIA questionnaire WA He atitiis B vaccination status present In ILIO 17. Aftercare instructions given to client I N/0 34 Restrooms available,stocked* 0 0 NIA 01L NIA Received by(Print): Wive_ 1� ��,e1,G Received by(Signature): Phone: U 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) Page lef_�F_