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Body Art Inspect*Report IR Date: ( 1 d I x <br /> _' oy <br /> San Joaquin County Environmental Health Department Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: rko S y 2 5C Z <br /> c (209)468-3420 Program / <br /> ptiFa'Ra` www.siopy.orp/ehd Element: l <br /> Facility Name Address City Zip Code <br /> Flying Crow Tattoo 245 w.yosemite ave. Manteca 95336 <br /> Name of Permit/Registration Holder Permit Exp.Date Time In Time Out Inspection Type <br /> Shawn Edwards 6/30/19 11:11 Routine <br /> The above facility is inspected for compliance with Division 104,Part 15,Chapter 7 of California Health and Safety Code(HSG). <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 Parts replaced between clients-grommets,elastic bands, Eltest El ❑ 22' etc. <br /> Items washed,disinfected,packaged,labeled,and <br /> El 2' sterilized E] 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 ❑ <br /> El 5. ElChemical used: <br /> appropriately <br /> ❑ 6 Invoices and log kept for disposable,pre-sterilized <br /> F1 25. Disinfectant used appropriately/sufficient contact time <br /> equipment <br /> ❑ 7 containers labeled,used,and disposed of E]Sharps conta <br /> a roph tel ❑ Wet contact time provided: <br /> [j 8 Jewelry,tattoo and piercing equipment-clean and <br /> sterilized El El 26. Barriers used El <br /> ❑ 27 Products applied to skin are single use/dispensed ElPRACTITIONER HEALTH AND HYGIENE 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 /> ® 11 Handwashing facilities properly supplied and accessible, Cross-contamination avoided during all phases of <br /> warm water El E] 30. procedure <br /> E] <br /> ❑ 12. Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES <br /> ❑ 13. Bloodborne Pathogen trainingEl [:1El31. Areas separated/no living or sleeping quarters <br /> Source: ❑ 32. Floors and walls clean and in good repair,adequate light ❑ <br /> ❑ 14. Appropriate personal protective equipment available and 01Workstation,surfaces,including chairs,armrests,etc. in <br /> used ❑ ® 33. good repair <br /> CUSTOMERS/CLIENTS ❑ 34. Perm it/registration posted ❑ <br /> Branding is completed with no other customers in <br /> ❑ 15. rocedure area ❑ El 35. Operation and employee training records present ❑ <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. and questionnaiEl El37. Permits obtained and available Elre <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 ❑ [__T141.1 ❑ <br /> Received b (Print): Shawn Edwards Received by(Signature): Phone: 209 629-8177 <br /> Specialist(Print): Jesse Easter,EHS 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 />