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"r.. Body Art Inspece Report 0 Date: /-Z7 J tS <br /> San Joaquin County Environmental Health Department Program � CV <br /> 1868 <br /> ; '* 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: PYA S� p 7�9 <br /> S �tAP" (209)468-3420 <br /> `'<< _ • ` www.siogv.oro/ehd Program �z� <br /> r Element: <br /> Facility Name Address City Zip Code <br /> Word of Mouth Tattoo 32 e.acacia st. Stockton 95202 <br /> Name of Permit/Registration Holder Permit Exp.Date Time In Time Out Inspection Type <br /> Sonny J Brown 6/30/15 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 El <br /> PREVENTING CROSS-CONTAMINATION <br /> ❑ 3. Autoclave loaded correctly/packages allowed to dry ❑ ❑ 23. 1 Workstation/procedure area decontaminated ElEl4. Integrators used/monthly spore test/log maintained ❑ ❑ 24. Appropriate chemical disinfectant used <br /> Decontamination/sanitation area separated and supplied ❑ <br /> ❑ 5' E] Chemical used: Cavacide <br /> appropriately <br /> ® <br /> Invoices and log kept for disposable,pre-sterilized 6• equipment El F125. Disinfectant used appropriately/sufficient contact time <br /> Sharps containers labeled,used,and disposed of El 7� a ro riatel ElWet contact time provided: 3-5 mins <br /> Jewelry,tattoo and piercing equipment-clean and <br /> El 8' El El 26. Barriers used <br /> sterilized <br /> Products applied to skin are single use/dispensed <br /> PRACTITIONER HEALTH AND HYGIENE El 27' asepticallyEl <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, El ❑ 30' Cross-contamination avoided during all phases of El❑ 11. warm water rocedure <br /> ❑ 12. Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES <br /> ® 13. Bloodborne Pathogen training ❑ ❑ 31. Areas separated/no living or sleeping quarters ❑ <br /> Source: International CPR Institute ❑ 32. Floors and walls clean and in good repair,adequate light ❑ <br /> Appropriate personal protective equipment available and El Workstation,surfaces,including chairs,armrests,etc.in <br /> ❑ 14. used ❑ 33. Workstation, <br /> repair ❑ <br /> CUSTOMERS/CLIENTS ❑ 34. Perm it/registration posted ❑ <br /> Branding is completed with no other customers in <br /> El ❑ 35. <br /> El 15. 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 /> ® <br /> Client records approved and available-Consent form 18' questionnaireEl El37. Permits obtained and available Eland <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 /> Received b (Print): Sonny J.Brown Received b (Signature• hone: 209 915-7018 <br /> Specialist(Print): Har rit Mattu,Sr REHS Specialist(Signature)7 Phone: 209 468-3284 <br /> Reinspecion on/about: A reinspection fee of$130 per hour may be charged. Page 1 of 2 <br /> EH-03/2015 <br />