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!N. o Body Art Inspean Report Date: I���� <br /> 4 San Joaquin County Environmental Health Department Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: hGu/ <br /> (209)468-3420 Program <br /> cq<J`F C7P�`P WWW Sroq V.Orq!ehd 14,NJ <br /> Element: <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 Routine/Final <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 ❑ ❑ 22 Parts replaced between clients-grommets,elastic bands, <br /> test etc. <br /> Items washed,disinfected,packaged,labeled,and <br /> ❑ 2" sterilized 1-1PREVENTING 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 /> ❑ 5 Decontamination/sanitation area separated and supplied ❑ Chemical used: Caviwipes C <br /> appropriatel <br /> ❑ 6 Invoices and log kept for disposable,pre-sterilized ❑ 25. Disinfectant used appropriately/sufficient contact time <br /> e ui ment [ <br /> ❑ 7 Sharps containers labeled,used,and disposed of ❑ Wet contact time provided: 3 min <br /> appropriate <br /> Jewelry,tattoo and piercing equipment-clean and <br /> El 8' El El26. Barriers used [ <br /> sterilized <br /> Products applied to skin are single use/dispensed <br /> PRACTITIONER HEALTH AND HYGIENE El 27' aseptically [ <br /> ❑ 9. No eating,drinking or smoking-clean clothes F11E:1 <br /> El28. 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, ❑ ❑ 30 Cross-contamination avoided during all phases of E <br /> warm water procedure <br /> ❑ 12. Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES <br /> ❑ 13. Bloodborne Pathogen training ❑ ❑ 31. Areas separated/no living or sleeping quarters [ <br /> Source: Biologix I ❑ 32. Floors and walls clean and in good repair,adequate light [ <br /> ❑ 14. Appropriate personal protective equipment available and ❑ ❑ 33 Workstation,surfaces, including chairs,armrests,etc.in [ <br /> used good repair <br /> CUSTOMERS/CLIENTS ® 34. Permit/registration posted [ <br /> Branding is completed with no other customers in <br /> F1 15. El ❑ 35. Operation and employee training records present [ <br /> procedure area <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 questionnaire ❑ ❑ 37. Permits obtained and available [ <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 by(Signature): _ Phone:(916)715-8401 <br /> Specialist(Print): Navjot Sahota Specialist(Signature): Phone:(209)468-3178 <br /> Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Page 1 of <br /> EH-11/17 <br />