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------ ------ - -------------- -- - - _ _. _ . - o`er ''"ao Body Art Inspection Report Date(MM/DD/YY) County of San Joaquin County,Environmental Health Department a_ f < 1868 E.Hazelton Ave.,Stockton CA 95205 Permit Number fR'OS3 � (2D9)468-3420 vAvw.sioov.ora/ehd . rC' u 1 Permit Type -1 Facility Name Address City Zip Code CT Q �..tlti wo�S e c s 1'�� l.o- u►� L Sho9S2 S Uu din n Permit/Registration Holder Name QPermit Exp.Date Total Time --� Inspection Type ES NI Sa-i nn 1,�,�2a. Fina SUIT C 24--in_14, 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 Com liance Out=Not in Compliance N/0=Not Observed N/A=Not Applicable COS=Corrected On Site ` -TAT PERMANENT COEMETICS�MACHINE `CLEANING'AND-STERILIZATION :our =cos- SAFETYA�1 ANITATfON. Til - In N/O 1. Autoclave is approved and effective-passed ❑ El In N/O 18. Safe machine design our. cos N/A integrator testN/A El 0i In N/O 2. Process of cleaning,labeling,packaging and ❑ In N10 19. Machines cleaned'and disinfected be N/A sterliziin items correctl N/A clients E03 101 In N/0 3. Autoclave loaded correctlylpackages allowed to ❑.. ❑ In N10 20. Parts replaced behheen clients-grommets, N/A d N/A elastic bands,etc. ❑ ❑ In N/O 4. Integrators used/monthly spore test/log PREVENTING CROSS CONTAMINATION N/A maintained 11 0 } In N/0 5. Decontamination/sanitation area separate and El ElInNNA/0 " 21, Workstation/procedure area decontaminated ❑ ❑ N/A supplied In N/0 6. Invoices and log kept for disposable,pre- El ❑ In N10 22. Chemical disinfectant used N/A sterilized equipment,backupsupplies available` NIA Chemical used: ❑ ❑ In N/0 7. Sharps containers supplied,labeled,used and In N/0 23. Disinfectant used sufficient contact time Wet N/A disposed of correctly 11 El N/A contact timeprovided: ❑ ❑ In N/0 8. Jewelry,tattoo and piercing equipment-storageEl ❑ In N/O 24. Barriers available and used as part of N/A and use Y N/Arocedure; 11 El = <« In NIO 25. Products applied to skin are single �i�RACTITIONERHEALTRANDHYGIENE .x NIA use/dispensed asetical) ❑ ❑ In N/O 9. No eating,drinking or smoking-clean clothes In N/0 26. Storage of inks,pigments,needles,tubes,etc., N/A ❑ ❑ NIA ❑ ❑ _ In N/0 10. Hands washed effectively and timely ❑ ❑ InNNA/0 27. Jewelry,Inks,Needles etc approved and used ❑ ❑ N/A In N/0 11. HandwashIng facilities properly supplied and ❑ ❑ In N/0 28. Cross-contamination avoided during all phases NIA accessible,warm potable water NIA of rocedure ❑ ❑ In N/O 12. Personal protective equipment available and BESTIBUSINE NIA SS PRACTICESk used,e ewash station available El � ? � z ,, CUSTOMERSlCLIENTS "' , In N10 29. Areas separated/no living or sleeping N/AUarferSlnO animals* El ❑ In N10 13. Branding is completed with no other customers in ❑ ❑ In N/O 30. Floors and walls clean and in good repair, N/A rocedure area N/A adequate light` ❑ ❑ = In NIO 14. Customers eighteen(18)years of age or older ❑ In N/0 31. Workstation,surfaces,including chairs,,etc.in NIA N/A ood re air,trash removed frequently ❑ ❑ _ In N/O 15. Skin prepared for procedure. In N/0 32. Perrrit/registration and required signposted s N/A N/A ❑ ❑ In N/O 16. Client records available-Consent form& ❑ ❑ In NIO 33. IPCP and employee training records and N/A uestionnaire NIA Hepatitiis 8 vaccination status resent ❑ ❑ In N10 17. Aftercare instructions given to client In N/0 34 Restrooms available,stocked N/A ❑ ❑ NIA ❑ ❑ eceived b (Print): . �] Received by(Signature): Phone: pecialist(Print): Specialist(Signature): Phone: This 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) _ Pagel of 3