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Body Art Inspect Report Date: h A <br /> ' San Joaquin County Environmental Health Department Program �7 <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: / Z J c� <br /> 9 <br /> (209)468-3420 Program •O <br /> www.sioqv.org/ehd <br /> Element: t <br /> Facility Name Address City Zip Code <br /> The Top Story 104 n.school st. Lodi 95240 <br /> Name of Permit/Registration Holder Permit Exp.Date Time In Time Out Inspection Type <br /> Teri L.Turrentine-Eisert Final Consult. <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, ❑ <br /> test etc. <br /> Items washed,disinfected,packaged,labeled,and <br /> ❑ 2. sterilized ❑ PREVENTING 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 El <br /> ❑ 5' a ro riatel E] Chemical used: Opticide <br /> Invoices and log kept for disposable,pre-sterilized <br /> ® 6" El [125. Disinfectant used appropriately/sufficient contact time <br /> equipment <br /> ElSharps containers labeled,used,and disposed of <br /> ❑ 7' a ro riatel El Wet contact time provided: 2 mins <br /> Jewelry,tattoo and piercing equipment-clean and <br /> ❑ 8. F1 El 26. Barriers used <br /> sterilized <br /> Products applied to skin are single use/dispensed <br /> PRACTITIONER HEALTH AND HYGIENE ❑ 27 ase tical) El <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 El <br /> ❑ 12. Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES <br /> ❑ 13. Bloodborne Pathogen training ❑ ❑ 1 31. Areas separated/no living or sleeping quarters ❑ <br /> Source: Cathie Montie ❑ 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. Perm it/registration posted ❑ <br /> Branding is completed with no other customers in <br /> ❑ 15. El El 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 /> Client records approved and available-Consent form <br /> ❑ 18. El [01E]37. Permits obtained and available <br /> 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 ❑ <br /> ❑ 21. Machines cleaned and disinfected between clients ❑ ❑ 4j. ❑ <br /> Received b Print): Teri L.Turrentine-Eisert Received b Si natur Phone: 209 365-3973 <br /> Specialist(Print): Har rit Mattu,Sr REHS Specialist(Signature): 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 />