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o au ry co Body Art Inspection Report Date(MM/DD/YY) - '- y County of San Joaquin County,Environmental Health Department w < 1866 E.Hazelton Ave.,Stockton CA 95205 Permit Number (209)468-3420 www.siq-ov.org/ehdt n O Permit Type Cf Facility Name Address City Zip Code CT PermitiRegistration Holder Name Permit Exp.Date Total Time Inspection Type �A v►n�� lam✓✓` k;-3 c-" 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 Compliance Out=Not in Compliance N/O=Not Observed NIA=Not Applicable COS=Corrected On Site a E COSH TIC CHINE ..; .__ :, CLEANING AND STERILIZATION our: cos S S TI N. rt,,. :, our COS In 1. Autoclave is approved and effective-passed 0 0 NIO 18. Safe machine design 0 11 1 integrator test NIA In XO 2. Process of cleaning,labeling,packaging and 13 07 1 N/0 19. Machines cleaned and disinfected between 0 0 1 stediziing items correctly A clients In NQ 3. Autoclave loaded correctly/packages allowed to In /0 20. Parts replaced between clients-grommets, dry Ij 13 NIA elastic bands,etc. In N 0 4. Integrators used/monthly spore test/log PRE VE INO CROSS-CONTAMINATION 11 1:1 All maintained In 10 5. Decontamination/sanitation area separate and 1 N/0 21. Workstation/procedure area decontaminated ❑ 0 N! supplied* NIA N10 6. Invoices and log kept for disposable,pre- 13 0 In N/0 22. Chemical disinfectant used 0 11I !A sterilized equipment,backu supplies available* INIA Chemical used: vCi n NIO 7. Sharps containers supplied,labeled,used and ❑ Eli WO 23. Disinfectant used gufficient contact time Wet 0 13 NIA disposed of correct) NIA contact timeprovided: _�l wL AIL nN/0 8. Jewelry,tattoo and piercing equipment-storage In N/0 24. Barriers available and used as part of 0 1:1N/A I and use N/A procedure In NIO 25. Products applied to skin are single 13 11 PRACTITIdNER HEALTH AND HYGIENE ' /A useldis ensed aseptically n 0 9. No eating,drinking or smoking-clean clothes I N/0 26. Storage of inks,pigments,needles,tubes,etc., 11 13 N1 WA ln,i 10. Hands washed effectively and timely ON/0 27. Jewelry,Inks,Needles etc approved and used El 0NI 13 11 I N/0 11. Handwashing facilities properly supplied and � In WPF Cross-contamination avoided during all phases 0 A accessible,warm potable water* NIA of procedure In N/0 12. Personal protective equipment available and B v Ti ; NIA used,eyewash station available* i tr CUSTOMERSICLIENTS In 29. Areas separated/no living or sleeping NIA uarters/no animals In0 13. Branding is completed with no other customers in 0 30. Floors and walls clean and in good repair, 11 0 /A procedure area lA adequate light In 10 14. Customers eighteen(18)years of age or older n l0 31. Workstation,surfaces,including chairs,,etc.in 0 11 NIA 11 0 A good repair;trash removed frequently O 15. Skin prepared for procedure. 1 0 In N/0 32. Permit/registration and required signs posted NIA A In 10 16. Client records available-Consent form& I N/0 33. IPCP and employee training records and IA questionnaire WA He atitiis B vaccination status present In N/O 17. Aftercare instructions given to client n /O 34 Restrooms available,stocked N/A (A Received by(Print): Received by(Signature): Phone: Specialist(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) Page L of-_