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�oa....... <br /> Body Art Inspect! Report 49 Date: h <br /> San Joaquin County Environmental Health Department <br /> Program 1 q <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 <br /> Record: <br /> p.• (209)468-3420 Program <br /> www.slogv.org/ehd 9 <br /> Element: Zd <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 /> V CLEANING AND STERILIZATION C V MACHINE SAFETY AND SANITATION(cont.) C <br /> ❑ I. Autoclave:approved and effective-passed integrator ❑ ❑ 22 Parts replaced between clients-grommets,elastic bands, ❑ <br /> test etc. <br /> Items washed,disinfected,packaged,labeled,and <br /> El 2' sterilized El CROSS-CONTAMINATION <br /> ❑ 3. Autoclave loaded correctly/packages allowed to dry ❑ [1 23. 1 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 /> El 5' ❑ Chemical used: Madacide <br /> appropriately <br /> 0 6. <br /> ro riatel <br /> Invoices and log kept for disposable,pre-sterilized <br /> ® 6• ui ment El El 25. Disinfectant used appropriately/sufficientcontact time <br /> E]Sharps containers labeled, used,and disposed of <br /> ® 7. a ro riatel ❑ I FWet contact time provided: 5-10 mins <br /> El8 Jewelry,tattoo and piercing equipment-clean and [-I [j26. Barriers used ❑ <br /> sterilized <br /> Products applied to skin are single use/dispensed <br /> PRACTITIONER HEALTH AND HYGIENE El 27. 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 /> ❑ <br /> Handwashing facilities properly supplied and accessible, El Cross-contamination avoided during all phases of 11. warm water El 30. procedure <br /> Cl <br /> ❑ 12. Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES <br /> ® 13. Bloodborne Pathogen training ❑ 31. Areas separated/no living or sleeping quarters ❑ <br /> Source: Cathie Montie ❑ 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 /> ❑ 14. used ❑ ® 33' good repair ❑ <br /> CUSTOMERS/CLIENTS ❑ 34. Perm it/registration posted ❑ <br /> Branding is completed with no other customers in <br /> El 15. ❑ ® 35. Operation and employee training records present Elrocedure area <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 /> ® <br /> Client records approved and available-Consent form 18. Eluestionnaire ❑ 37. Permits obtained and available <br /> and ❑ <br /> ❑ 19. Appropriate aftercare instructions given to client ❑ ❑ 38. Impoundment ❑ <br /> MACHINE SAFETY AND SANITATION ❑ 39. Hearing scheduled ❑ <br /> ❑ 20. Safe machine design ❑ ❑ 40. Closure ❑ <br /> ❑ 21. Machines cleaned and disinfected between clients ❑ ❑ 41. ❑ <br /> s <br /> r <br /> Received b (Print): Souk Rattanasack Received by(Signature): (4Phone: 209 333-1631 <br /> Specialist(Print): Harprit Mattu,Sr REHS Specialist Si nature): hone: 209 468-3284 <br /> .71 <br /> Reinspecion on/about: A reinspection fee of$130 per hour may be charged. �ge 1 of 2 <br /> EH-03/2015 <br />