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Body Art Inspecli Report • Date: 2 <br /> SanJoaquin County Environmental Health Department Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: SWC 7$v <br /> (209)468-3420 <br /> www.siogv.org/ehd Program 11103"�• ,O 3 <br /> Element: <br /> Facility Name Address City Zip Code <br /> Flying Crow Tattoo 245 w.yosemite avenue Manteca 95336 <br /> Name of Perm it/Registration Holder Permit Exp. Date Time In Time Out Inspection Type <br /> Shawn Edwards 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 /> Alai 1 0 IN <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 /> El 2' sterilized ❑ <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 <br /> El 5' appropriately E] Chemical used: Madacide <br /> Invoices and log kept for disposable, pre-sterilized <br /> ® 6. El 25. Disinfectant used appropriately/sufficient contact time <br /> equipment <br /> ElSharps containers labeled, used,and disposed of <br /> ® 7' E] Wet contact time provided: 6 mins <br /> appropriately <br /> ❑ 8 Jewelry,tattoo and piercing equipment-clean and ❑ ❑ 26. Barriers used ❑ <br /> sterilized <br /> El 27 Products applied to skin are single use/dispensed ❑ <br /> aseptically <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❑ El30Cross-contamination avoided during all phases of 11. warm water . procedure <br /> El <br /> ❑ 12. Hepatitis B vaccination ❑ <br /> fwir ti� <br /> 04, ur'1011 <br /> ❑ 13. Bloodborne Pathogen trainingE] ElE]31. Areas separated/no living or sleeping quarters <br /> Source: ® 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 /> El 14. used 1:1 ❑ 33' ood repair <br /> E] <br /> � �;. <br /> ❑ 34. Permit/registration posted <br /> Branding is completed with no other customers in <br /> kill <br /> El 15. procedure area El ® 35. Operation and employee training records present E] <br /> ❑ 16. Customers eighteen(18)years of age or older ❑ � u <br /> ❑ 17. Skin adequately prepared for procedure ❑ ❑ 36. Plan(s)submitted for review ❑ <br /> ® <br /> Client records approved and available-Consent form 18. El ❑ 37. Permits obtained and available E]andquestionnaire <br /> ❑ 19. Appropriate aftercare instructions given to client ❑ ❑ 38. Impoundment ❑ <br /> ❑ 39. Hearing scheduled ❑ <br /> ❑ 20. Safe machine design ❑ ❑ 40. Closure ❑ <br /> ❑ 21. Machines cleaned and disinfected between clients ❑ ❑ 41. El1 <br /> Received b (Print): Shawn Edwards Received b `k <br /> (Signature):: l0.t Phone: <br /> Specialist(Print): Har rit Mattu,Sr REHS Specialist(Signature): Phone: 209 468-3284 <br /> Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Page 1 of 2 <br /> EH-11/17 <br />