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Body Art Inspection Report Date(MM/DD/YY) County of San Joaquin County,Environmental Health Department 1868 E.Hazelton Ave.,Stockton CA 95205 Permit Number (209)468-3420 www.siaov.ora/ehd All W Permit Type Q i Facility Name Address City Zip,Godg CT I.,,.��,�c�¢�MSt4 3q' til• Sh��wy�trr./•_�__S"'�t ems+' Go�� SZ�j'O r Perini/Registration Holder Name Permit Exp.Date Total Time Inspection Type RISK FACTORS AND INTERVENTIONS Risk factors are improper practices or procedures idenfrfted as contributing factors of cross-contamination. Interventions are control measures to prevent cross-contamination and transfer of pathogens from one person to another. In=In Compliance Out=Not in Compliance NIO=Not Observed N/A=Not Applicable COS=Corrected On Site ;TATTOO AND PERMANENT COSMETICS MACHINE LEANikAlI S FR�LIZA' . . t , oui cos SAFETY AND SANITATION,.. our cos' In N/O 1. Autoclave is approved and effective .passed In NIO 18. Safe machine design N/A integrator test ❑ 13 In In N/0 2. Process of cleaning,labeling,packaging and ❑ In NIO 19. Machines cleaned and disinfected between 0 0 N/A stediziing items corrects N/A clients In N/0 3. Autoclave loaded correctly/packages allowed to ❑ In N/0 20. Parts replaced between clients-grommets, 0 0 N/A dry N/A elastic bands,etc. In N/0 4. Integrators used/monthly spore test/log PREVENTING CROSS-CONTAMINATION ❑ ❑ a � N/A maintained In N/0 5. Decontamination/sanitation area separate and 0 0 In N10 21. Workstation/procedure area decontaminated ❑ N/A supplied* NIA In NIO 6. Invoices and log kept for disposable,pre- 0 0 In N/0 22. Chemical disinfectant used 0 0 N/A sterilized equipment,backu supplies available I N/A Chemical used: In N/0 7. Sharps containers supplied,labeled,used and ❑ ❑ In NJO 23. Disinfectant used sufficient contact time Wet 0 0 NIA disposed of correct) ` NIA contact timeprovided: In NIO 8. Jewelry,tattoo and piercing equipment-storage11In N/0 24. Barriers available and used as part of 11 0 NIA and use NIA procedure` In N/0 25. Products applied to skin are single 0 0 PRACTITIONER HEALTH AND'HYGIENE NIA useldis ensed aseptically In N/0 9. No eating,drinking or smoking-clean clothes 0 0 In N/0 26. Storage of inks,pigments,needles,tubes,etc., 0 0 N/A N/A In N/0 10. Hands washed effectively and timely 0 ❑ In NIO 27. Jewelry,Inks,Needles etc approved and used 0 0 N/A N1A In N/0 11. Handwashing facilities properly supplied and 0 0 In N/0 28. Cross-contamination avoided during all phases 0 ❑ N/A accessible,warm potable water` N/A of procedure In N/0 12. Personal protective equipment available and13 0 BEST BUSINESS PRACTICES N/A used,eyewash station available n , CUSTOMERSJCLIENTS " In N/0 29. Areas separated/no living or sleeping ❑ ❑ N/Aquarters/no animals In N/0 13. Branding is completed with no other customers in 0 0 in N10 30. Floors and walls clean and in good repair, 0 0 N/A procedure area NIA adequate light` In N/0 14. Customers eighteen(18)years of age or older 0 0 In N/0 31. Workstation,surfaces,including chairs,,etc.In 0 0 NIA N/A good repair,trash removed frequently` In N/0 15. Skin prepared for procedure. 0 0 In N10 32. Permit/registration and required signs posted` ❑ 0 NIA N/A In N/0 16. Client records available-Consent form& 0 0 In NIO 33. IPCP and employee training records and 0 0 N/A questionnaire NIA Hepafitiis B vaccination status present In N/0 17. Aftercare instructions given to client 0 0 In N/0 34 Restrooms available,stocked` 0 0 N/A NIA Received by(Print): Sem r►'a4G-•L Received by(Signature): Phone: Specialist(Print): 1159& Specialist(Signature): Phone: f 41 aThis report is an Official Notice of Violation.Corrections must be completed in the time specified. A reinspection fee maybe charged if violations noted on this report are not corrected by the reinspection date. Reinspection Date(on or about) Page-of_