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U1 .coy <br /> Body Art Inspect* Report Date: 11117115 <br /> San Joaquin County Environmental Health Department Program OCL <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: 5F-OG <br /> 3 S o l7 <br /> (209)468-3420 <br /> Program <br /> 1 cdClFaRr'`P www-siogv.org/ehd Element: -U <br /> I iO 3 <br /> Facility Name Address City Zip Code <br /> ?ak2- <br /> Mudville fiats Studio 127 w.harding way#B Stockton 95204 <br /> Name of Perm it/Registration Holder Permit Exp. Date Time In Time Out Inspection Type <br /> Gustavo Hurtado Initial 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 /> F] 2' sterilized ❑ PREVENTING 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 Chemical used: Madacide El <br /> El 5. appropriately <br /> El <br /> Invoices and log kept for disposable,pre-sterilized <br /> ® 6• equipment El 25. Disinfectant used appropriately/sufficient contact time <br /> ® 7 Sharps containers labeled,used,and disposed of ElWet contact time provided: 3 mins <br /> appropriately <br /> ❑ 8 Jewelry,tattoo and piercing equipment-clean and ❑ ❑ 26. Barriers used ❑ <br /> sterilized <br /> Products applied to skin are single use/dispensed <br /> PRACTITIONER HEALTH AND HYGIENE ❑ 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, Cross-contamination avoided during all phases of <br /> ® 11 E] 30.warm water procedure ❑ <br /> ❑ 12. Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES <br /> ® 13. Bloodborne Pathogen training ElEl31. Areas separated/no living or sleeping quarters E]Source: Cathie Montie ® 32. Floors and walls clean and in good repair,adequate light ❑ <br /> ❑ 14. Appropriate personal protective equipment available and ® 33 Workstation,surfaces,including chairs,armrests,etc. in ❑ <br /> used good repair <br /> CUSTOMERS/CLIENTS ❑ 34. Permit/registration posted ❑ <br /> Branding is completed with no other customers in <br /> El 15. F1El❑ 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. ❑ ® 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 ❑ rEl"41. ❑ <br /> Received b (Print): Gustavo Hurtado Received b Si nature):4 Phone: 209)546-2739 <br /> Specialist Print): Harprit Mattu,Sr REHS Specialist(Signature): Phone: 209 468-3284 <br /> Ir <br /> Reinspecion on/about: A reinspection fee of$130 per hour may be charged. Page 1 of 2 <br /> EH-03/2015 <br />