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Body Art Inspeco Report • Date: _ <br /> San Joaquin County Environmental Health Department <br /> Programa-1 <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 <br /> i Record: <br /> (209)468-3420 Program <br /> www.siogv.orglehd 11 i �1 <br /> Element: <br /> Facility Name Address City Zip Code <br /> Tobacco City 550 s cherokee lane Lodi 95240 <br /> Name of Permit/Registration Holder Permit Exp.Date Time In Time Out Inspection Type <br /> Rattanasack,Souk 6/30/14 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 ❑ ❑ 7Parts replaced between clients-grommets,elastic bands, ❑ <br /> test etc. <br /> Items washed,disinfected,packaged,labeled,and <br /> ❑ 2' sterilized El 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 /> Decontamination/sanitation area separated and supplied ❑ <br /> ❑ 5' ❑ Chemical used: <br /> appropriately6 Invoices and log kept for disposable,pre-sterilized ❑ ❑ 25. Disinfectant used appropriately/sufficient contact time <br /> equipment ❑ <br /> 7 Sharps containers labeled,used,and disposed of ❑ Wet contact time provided: <br /> appropriately <br /> ❑ <br /> Jewelry,tattoo and piercing equipment-clean and 8' El 1:126. Barriers used <br /> sterilized ❑ <br /> 27 Products applied to skin are single use/dispensed ElPRACTITIONER 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, ❑ ❑ 30 Cross-contamination avoided during all phases of Elwarm water procedure <br /> ❑ 12. Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES <br /> 13. Bloodbome Pathogen training ❑ ❑ 31. Areas separated/no living or sleeping quarters ❑ <br /> Source: Dal32. Floors and walls clean and in good repair,adequate light ❑ <br /> ❑ 14 Appropriate personal protective equipment available and ❑ ❑ 33 Workstation,surfaces,including chairs,armrests,etc.in Elused good repair <br /> CUSTOMERSlCLIENTS E] 34. Perm it/registration posted ❑ <br /> Branding is completed with no other customers in <br /> ❑ 15. ❑ 35. Operation and employee training records present <br /> procedure 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 /> 18 Client records approved and available-Consent form El El37. Permits obtained and available E]and questionnaire <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 El <br /> ❑ 21. Machines cleaned and disinfected between clients ❑ I ❑ 1 41. ❑ <br /> Received b (Print): Rattanasack Souk Received by(Signature): Phonk <br /> Specialist(Print): Afonso Arambula Specialist(Signature)7 Phone: 209 468-9673 <br /> Reinspecion on/about: A reinspection fee of$125 per hour may char9 Page 1 of 2 <br /> . <br /> EH-04/2014 <br />