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Bodyrns a ors <br /> At Ip � Report p I Is Date: <br /> ly <j San Joaquin County Environmental Health Department Program Gots <br /> J 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: DO� !O 7 <br /> (209)468-3420 Program <br /> lFQRj www.siogv.org/ehd Element: `/�!I0:!1 <br /> Facility Name Address City Zip Code <br /> Hi Pretty! 510 s.fairmont,suite 8 Lodi 95240 <br /> Name of Permit/Registration Holder Permit Exp. Date Time In Time Out Inspection Type <br /> Elisabeth Marie Graffin 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 /> yi`;�`. <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 ENTINGe S�ON7AMINAT4 <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 /> Decontamination/sanitation area separated and supplied El <br /> El 5' a ropriatel ❑ Chemical used: Barbicide,Caviwipes <br /> Invoices and log kept for disposable, pre-sterilized <br /> ® 6. El ® 25. Disinfectant used appropriately/sufficient contact time <br /> equipment <br /> ElSharps containers labeled, used,and disposed of <br /> ® 7' E] Wet contact time provided: N/A <br /> appropriately <br /> [_1 8. <br /> ro riatel <br /> Jewelry,tattoo and piercing equipment-clean and <br /> [_1 8' El El 26. Barriers used Elsterilized <br /> 27 Products applied to skin are single use/dispensed ❑ <br /> 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,® 30Cross-contamination avoided during all phases of 11. warm water ❑ ® ' procedure ❑ <br /> -z * <br /> S' ' A <br /> El 12. <br /> � <br /> 12. Hepatitis B vaccination 60 CTICES } . <br /> ® 13. Bloodborne Pathogen training ❑ ❑ 31. Areas separated/no living or sleeping quarters ❑ <br /> Source: Cathy Montie ❑ 32. Floors and walls clean and in good repair,adequate light ❑ <br /> ❑ <br /> Appropriate personal protective equipment available and Workstation,surfaces, including chairs,armrests,etc. in 14. used ❑ ❑ 33. good repair ❑ <br /> te §$ El34. Permit/registration posted ❑ <br /> CSQ HSS .. <br /> ❑ <br /> Branding is completed with no other customers in 15. El ® 35. Operation and employee training records present E]rocedure area <br /> 4" *� SLYy�C �3s r�ii h c'"gY S t <br /> ® 16. Customers eighteen(18)years of age or older ❑ ' <br /> (ELAND E ��° � . ��5�k � �� <br /> ❑ 17. Skin adequately prepared for procedure ❑ ❑ 36. Plan(s)submitted for review ❑ <br /> Client records approved and available-Consent form <br /> ® 18. E] El37. Permits obtained and available Elandquestionnaire <br /> ® 19. Appropriate aftercare instructions given to client ❑ ❑ 38. Impoundment ❑ <br /> f ' € ❑ 39. Hearing scheduled ❑ <br /> ❑ 20. Safe machine design ❑ ❑ 40. Closure ❑ <br /> ❑r2l, Machines cleaned and disinfected between clients ❑ ❑ 41. ❑ <br /> Received by(Print): Elisabeth Marie Graffin Received by(Signature): UMA'II.M Phone: (209)712-1273 <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 3 <br /> EH-11/17 <br />