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t Body Art InspecReport Date: 2 5he 1-7 <br /> San Joaquin County nvironmental Health Department ProgramGPNn 2 <br /> ! 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: <br /> r (209)468-3420 Program <br /> www.siogv.org/ehd y`2� <br /> _. . Element: <br /> Facility Name Address City Zip Code <br /> Tobacco City 550 s.cherokee In.ste g Lodi 95240 <br /> Name of Permit/Registration Holder Permit Exp. Date Time In Time Out Inspection Type <br /> Souk Rattanasack 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 /> ❑ 1 Autoclave:approved and effective-passed integrator ❑ ❑ 22. Parts replaced between clients-grommets,elastic bands, ❑ <br /> testetc. <br /> Items washed,disinfected, packaged, labeled,and <br /> 2. <br /> sterilized ❑ _ <br /> El <br /> . . <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 /> Decontamination/sanitation area separated and supplied ❑ <br /> ❑ 5' ElChemical used: <br /> appropriately <br /> 6. <br /> ro riatel <br /> ❑ <br /> Invoices and log kept for disposable,pre-sterilized 6' equipment ❑ El25. Disinfectant used appropriately/sufficient contact time <br /> Sharps containers labeled, used,and disposed of El <br /> ❑ 7. appropriately <br /> El Wet contact time provided: <br /> Jewelry,tattoo and piercing equipment-clean and <br /> El 8' El El26. Barriers used Elsterilized <br /> El Products applied to skin are single use/dispensed <br /> 1. 27. asepticallyEl <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 /> Handwashing facilities properly supplied and accessible, Cross-contamination avoided during all phases of <br /> ❑ 11. warm water El ❑ 30. rocedure El <br /> ❑ 12. Hepatitis B vaccination ❑ �` <br /> m� <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 /> Appropriate personal protective equipment available and Workstation,surfaces, including chairs,armrests,etc. in <br /> ONION W-1-01E] 14. Elused r[01 <br /> 33' ood re air E]gyp. 34. Perm it/registration posted ElBranding is completed with no other customers inEl15. rocedure area El 35. Operation and employee training records present ❑ <br /> ❑ 16. Customers eighteen(18)years of age or older ❑ no R <br /> ❑ 17. Skin adequately prepared for procedure ❑ ❑ 36. Plan(s)submitted for review ❑ <br /> Client records approved and available-Consent form <br /> El 18. El El37. Permits obtained and available Elandquestionnaire <br /> ❑ 19. Appropriate aftercare instructions given to client ❑ ❑ 38. Impoundment ❑ <br /> ❑ 39. Hearing scheduled ❑ <br /> ❑ 20. Safe machine design ❑ ❑ 40. Closure ❑ <br /> ❑ 21. Machines cleaned and disinfected between clients ❑ r[- 41. ❑ <br /> Received b (Print): Received by(Signature): 04 Phone: 209 333-1631 <br /> Specialist(Print): Har rit Mattu, Sr REHS Specialist(Signature): Phone: 209 468-3284 <br /> Reinspecion on/about: A reinspection fee of$130 per hour may be charged. Page 1 of 2 <br /> EH-03/2015 <br />