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Body Art Ins <br /> o pect Report Date: <br /> :...� <br /> San Joaquin County Environmental Health Department Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: <br /> (209)468-3420 <br /> Program F� <br /> q� •..• ` www.siogv.org/ehd /r <br /> Element: <br /> Facility Name Address City Zip Code <br /> Gypsy Lantern 8909 s thornton rd Stockton 95207 <br /> Name of Permit/Registration Holder Permit Exp.Date Time In Time Out Inspection Type <br /> Nicholas Hernandez 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 ❑ ❑ 22 Parts replaced between clients-grommets,elastic bands, Eltest etc. <br /> ❑ <br /> Items washed,disinfected,packaged,labeled,and 2' sterilized 11PREVENTING CROSS-CONTAMINATION <br /> ❑ 3. Autoclave loaded correctly/packages allowed to dry ❑ ® 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 El <br /> ❑ 5' <br /> appropriately <br /> ❑ Chemical used: <br /> Invoices and log kept for disposable,pre-sterilized <br /> ® 6• ❑ El 25. Disinfectant used appropriately/sufficient contact time <br /> equipment <br /> ElSharps containers labeled,used,and disposed of <br /> ® 7 11a ro <br /> appropriately <br /> [Wet contact time provided: <br /> Jewelry,tattoo and piercing equipment-clean and <br /> 8' El El 26. Barriers used <br /> sterilized <br /> Products applied to skin are single use/dispensed <br /> PRACTITIONER HEALTH AND HYGIENE ❑ 27' ase ticali ❑ <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' procedure E] <br /> ❑ 12. Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES <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 /> ❑ 14. used ❑ ❑ 33' good repair ❑ <br /> CUSTOMERS/CLIENTS ❑ 34. Permittregistration posted ❑ <br /> Branding is completed with no other customers in <br /> El 15. ❑ El 35. Operation and employee training records present E]rocedure area <br /> ❑ 16. Customers eighteen(18)years of age or older ❑ COMPLIANCE AND ENFORCEMENT <br /> El17. Skin adequately prepared for procedure ❑ [136. Plan(s)submitted for review- ❑ <br /> Client records approved and available-Consent form <br /> ® 18. ❑ El 37. Permits obtained and available <br /> and questionnaire <br /> ❑ 19. Appropriate aftercare instructions given to client ❑ ❑ 38. Impoundment El <br /> MACHINE SAFETY AND SANITATION ❑ 39. Hearing scheduled ❑ <br /> ❑ 20. Safe machine design ❑ ❑ 40. Closure ❑ <br /> ❑ 21. Machines cleaned and disinfected between clients ❑ r[_]� 41. ❑ <br /> Received b (Print): Nicholas Hernandez Received by(Signature): Phone:-2099228792 <br /> Specialist(Print): Afonso Arambula Specialist(Signature): Phone: 209 468-9673 <br /> Reinspecion onlabout: A reinspection fee of$125 per hour may 1haVg Page 1 of 3 <br /> EH-04/2014 <br />