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' Body Art Inspects Report Date: 5/_2 1/18 <br /> San Joaquin County Environmental Health Department Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: 'S g 007 q <br /> (209)468-3420 Program //LL <br /> www.sioov.org/ehd Element: 7/G 3 <br /> Facility Name Address City Zip Code <br /> Relax Hermosa 39 n sacramento st. Lodi 95240 <br /> Name of Permit/Registration Holder Permit Exp. Date Time In Time Out Inspection Type <br /> Jessica Hernandez 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 /> r <br /> w <br /> ❑ 1 Autoclave:approved and effective-passed integrator ❑ ❑ 22. Parts replaced between clients-grommets,elastic bands, ❑ <br /> testetc. <br /> Items washed,disinfected,packaged,labeled,and <br /> 1:12' sterilized E] <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 /> ❑ <br /> Decontamination/sanitation area separated and supplied 5. ElChemical used: Barbicide,Cavicide spray,Caviwipes <br /> appropriately <br /> ® <br /> Invoices and log kept for disposable,pre-sterilized 6• equipment El El25. Disinfectant used appropriately/sufficient contact time <br /> ® <br /> Sharps containers labeled, used,and disposed of 7• ElWet contact time provided: 10-15 min,5-10 min <br /> appropriately <br /> ❑ 8 Jewelry,tattoo and piercing equipment-clean and ❑ ❑ 26. Barriers used ❑ <br /> sterilized <br /> s c> fi ® <br /> 27. Products applied to skin are single use/dispensed ❑ <br /> .j'RACTITIONER HEALTH AND HYGIENE ,>, , r raseptically <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,® 30Cross-contamination avoided during all phases of 11. warm water ❑ ❑ . procedure ❑ <br /> ❑ 12. Hepatitis B vaccination ❑ <br /> ❑ 13. Bloodborne Pathogen training ❑ 31. Areas separated/no living or sleeping quarters ❑ <br /> Source: Abovetraining.com ❑ 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 /> El14. used El 3333' good repair ❑ <br /> ❑ 34. Permit/registration posted El <br /> Branding is completed with no other customers in <br /> El 15. El El 35. Operation and employee training records present E]rocedure area <br /> ❑ 16. Customers eighteen(18)years of age or older ❑ <br /> ❑ 17. Skin adequately prepared for procedure ❑ [j 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 E]and <br /> ® 19. Appropriate aftercare instructions given to client ❑ ❑ 38. Impoundment ❑ <br /> MACHINE SAFETY ANDSANjTjATIONL ., ,� ❑ 39. Hearing scheduled ❑ <br /> ❑ 20. Safe machine design ❑ ❑ 40. Closure E] <br /> 40. <br /> Machines cleaned and disinfected between clients El M[] 41. ❑ <br /> Received by(Print): Jessica Hernandez Received by(Signature): EMAI tED Phone: (209)263-9881 <br /> Specialist(Print): Navjot Sahota Specialist(Signature): U/moi _S�Olr Phone: (209)468-3178 <br /> Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Page 1 of 2 <br /> EH-11/17 <br />