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Body Art InspecOn Report it Date: �° b <br /> a<} San Joaquin County Environmental Health Department Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: <br /> (209)468-3420 <br /> Program IOL <br /> Crjep.a' www.siogv.orq/ehd <br /> Element: <br /> Facility Name Address City Zip Code <br /> Living Water Studios 210 n.main st. Manteca 95336 <br /> Name of Permit/Registration Holder Permit Exp.Date Time In Time Out Inspection Type <br /> Thomas Shea 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 I etc. <br /> Items washed,disinfected,packaged,labeled,and <br /> ❑ 2. sterilized El 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 ❑ <br /> ❑ 5' ElChemical used: <br /> appropriately <br /> Z 6. <br /> ro riatel <br /> Invoices and log kept for disposable,pre-sterilized <br /> ® 6• El El 25. Disinfectant used appropriately/sufficient contact time <br /> equipment <br /> Sharps containers labeled,used,and disposed of ❑ <br /> ❑ 7 appropriately E] Wet contact time provided: <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' aseptically ❑ <br /> ❑ 9. No eating,drinking or smoking-clean clothes [:1 El 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, 30Cross-contamination avoided during all phases of <br /> ® 11. warm water rED <br /> . procedureE]El12. Hepatitis B vaccination BEST BUSINESS PRACTICES <br /> F113. Bloodborne Pathogen training [j31. Areas separated/no living or sleeping quarters EJ <br /> Source: ® 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. Permittregistration posted ❑ <br /> Branding is completed with no other customers in <br /> El 15. El ® 35. Operation and employee training records present Elrocedure 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. questionnaire <br /> El El 37. Permits obtained and available <br /> and ❑ <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): Thomas Shea Received b (Signature): Phone:(209)696-0713 <br /> Specialist(Print): Benjamin Escotto,Sr REHS Specialist(Signature): Phone: 209 468-3178 <br /> Reinspecion on/about: A reinspection fee of$130 per hour may be charged. Page 1 of 2 <br /> EH-03/2015 <br />