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f <br /> Body Art Inspect Report Date: <br /> l San Joaquin County Environmental Health Department Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: <br /> P, (209)468-3420 Program <br /> E,� i www.sio4v.or4/ehd Element: <br /> Facility Name Address City Zip Code <br /> Name of Perm it/Registration Holder Permit Exp. Date Time In Time Out Inspection Type <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 /> -- � a r � <br /> a � � Iw <br /> - '' MOM <br /> r � <br /> tis P = <br /> ❑ 1 Autoclave:approved and effective-passed integrator ❑ ❑ 22 Parts replaced between clients-grommets,elastic bands, ❑ <br /> test etc. <br /> El 2 Items washed,disinfected, packaged, labeled, and ❑ <br /> 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 /> ❑ 5 Decontamination/sanitation area separated and supplied ❑ Chemical used: ❑ <br /> a ro riatel <br /> Invoices and log kept for disposable,pre-sterilized <br /> 6' r0_1 <br /> El 25. Disinfectant used appropriately/sufficient contact time <br /> equipment <br /> Sharps containers labeled, used,and disposed of ❑ <br /> ❑ 7' appropriately Wet contact time provided:8 Jewelry,tattoo and piercing equipment-clean and El26. Barriers used ❑ <br /> sterilized <br /> 27 Products applied to skin are single use/dispensed E].g <br /> i ` _ 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, Cross-contamination avoided during all phases of <br /> El 11. warm water E] 30' procedure El <br /> 7 '1iMOP <br /> � <br /> 12. Hepatitis B vaccination � UT <br /> � x o4u <br /> 13. Bloodborne Pathogen training E] ❑ 31. Areas separated/no living or sleeping quarters ❑ <br /> Source: 32. Floors and walls clean and in good repair,adequate light ❑ <br /> Appropriate persona pr tective equipment available and Workstation,surfaces, including chairs,armrests,etc.in <br /> ❑ 14. used ❑ 1 33' good repair ❑ <br /> ❑ 34. Permit/registration posted ❑ <br /> Nffl <br /> Branding is completed with no other customers in <br /> El 15. El El35. Operation and employee training records present ❑ <br /> procedure area <br /> qj <br /> ❑ 9hteen <br /> 16. Customers ei age or older ❑ ��' <br /> (18)years of 9 � M �fifr <br /> ❑ 17. Skin adequately prepared for procedure ❑ ❑ 36. Plan(s)submitted for review ❑ <br /> 18 Client records approved and available-Consent form ❑ ❑ 37. Permits obtained and available ❑ <br /> and questionnaire <br /> 19. Appropriate aftercare instructions given to client ❑ ❑ 38. Impoundment ❑ <br /> M60 <br /> El 39. Hearing scheduled ❑ <br /> ❑ 20. Safe machine design ❑ ❑ 40. Closure ❑ <br /> ❑ 21. Machines cleaned and disinfected between clients ❑ r[__1 r4l.T ❑ <br /> Received by(Print): Received by(Signature): Phone: <br /> Specialist(Print): Specialist(Signature): Phone: <br /> Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Page 1 of 2 <br /> EH-11/17 <br />