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Body Art Inspect* Report i <br /> Date: l /Yj/dy <br /> C, San Joaquin County Environmental Health Department Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: ®off 99_9W <br /> (209)468-3420 Program <br /> www.sioov.org/ehd Element: N00;3 <br /> Facility Name Address City Zip Code <br /> Dreamscape Brows 3422 w. hammer lane,suite j Stockton 95219 <br /> Name of Permit/Registration Holder Permit Exp. Date Time In Time Out Inspection Type <br /> Fong Vang 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 /> V CLEANING AND STERILIZATION C V MACHINE SAFETY AND SANITATION(cont.) C <br /> ❑ 1 Autoclave:approved and effective-passed integrator [�P-,rts replaced between clients-grommets,elastic bands, ❑test ❑ ❑ 22' . <br /> ❑ 2 Items washed,disinfected, packaged, labeled,and <br /> sterilized El CROSS-CONTAMINATION' <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 /> El5 Decontamination/sanitation area separated and supplied ❑ <br /> appropriately ❑ Chemical used: Caviwipes <br /> ❑ 6 Invoices and log kept for disposable,pre-sterilized <br /> equipment El 25. Disinfectant used appropriately/sufficient contact time <br /> ® 7 Sharps containers labeled, used,and disposed of ❑ <br /> appropriate) ❑ Wet contact time provided: 3 min <br /> ❑ 8 Jewelry,tattoo and piercing equipment-clean and <br /> El El26. Barriers used <br /> sterilized ❑ <br /> ❑ 27 Products applied to skin are single use/dispensed ElPRACTITIONER HEALTH AND HYGIENE asepticall <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 ❑ 30. rocedure <br /> ❑ 12. Hepatitis B vaccination ❑ <br /> BEST BUSINESS PRACTICES <br /> ® 13. Bloodborne Pathogen training ❑ TE133. <br /> Areas separated/no living or sleeping quarters ❑ <br /> Source: Floors and walls clean and in good repair,adequate light ❑ <br /> ❑ 14. Appropriate personal protective equipment available and Workstation,surfaces, including chairs,armrests,etc. in ❑ <br /> used ❑ ood re air <br /> CUSTOMERS/CLIENTS ❑ 34. Permit/registration posted ❑ <br /> ❑ 15. Branding is completed with no other customers in <br /> rocedure area [j 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 /> ® 18 Client records approved and available-Consent form <br /> and uestionnaire El El 37. Permits obtained and available 1:1 <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 ❑ ❑ 41. ❑ <br /> Received b (Print): Fong Vang Received b (Signature): Phone: (916)715-8401 <br /> Specialist(Print): Navjot Sahota Specialist(Signature): i 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 />