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Body Art Inspection Report Date: 05/08/2025 u San Joaquin County Environmental Health Department Program 1868 E.Hazelton Ave.,Stockton.CA 95205 Record: PRO546555 (209)468-3420 —Sioov ora/ehd Program" tr�oaaY Element: 4120 Facility Name Address City Zip Code One Time Tattoo 407 N.Main St Manteca 95336 Name of Permit/Registration Holder Pencil Grp.Date Time In Time Out Inspection Type Jesus Gadbay 06/30/2025 Routine The facility is inspected for compliance with Division 104,Part 15,Chapter 7 of California Health and Safety Code(HSC). V=Violation C=Corrected On Site V CLEANING AND STERILIZATION C V I MACHINE SAFETY AND SANITATION cont C ❑ HSC 119315-Autoclave:approved and effective-passed HSC 119311 -Parts replaced between clients-grommets, 1' integrator test El ❑ 22. elastic bands,etc. ❑ ❑ HSC 119309-Items washed,disinfected,packaged,2' labeled,and sterilized ❑ PREVENTING CROSS-CONTAMINATION ❑ 3 HSC 119315-Autoclave loaded correctly/packages ❑ ❑ 23. HSC 119309-Workstation/procedure area decontaminated ❑ allowed to dry ❑ HSC 119315-Integrators used/monthly spore testAog 4. maintained ❑ 24. HSC 119301-Appropriate chemical disinfectant used HSC 119314-Decontamination/sanitation area separated ❑ ❑ ❑ 5' 1 and supplied appropriately ❑ Chemical used: HSC 119315-Invoices and log kept for disposable,pre- HSC 119309-Disinfectant used appropriately/sufficient ® 6' sterilized equipment ❑ ❑ 25' contact time Cl HSC 119314-Sharps containers labeled,used,and ❑ 7' disposed of a ro date) ❑ Wet contact time provided: ❑ 8 HSC 119310, 119315-Jewelry,tattoo and piercing ❑ ❑ 26. HSC 119314-Barriers used ❑ equipment-clean and sterilized HSC 119311 -Products applied to skin are single PRACTITONER HEALTH AND HYGIENE ❑ 27" use/dispensed aseptically ❑ ® 9 HSC 119309-No eating,drinking or smoking-clean ❑ ❑ 28 HSC 119309,119311 -Storage of inks,pigments,needles, ❑ clothes tubes etc. ❑ 10. HSC 119308-Hands washed effectively and timely ❑ ❑ 29 HSC 119310, 119311 -Jewelry,Inks,Needles etc approved ❑ and used correct) ❑ 11. HSC 119314-Handwashing facilities properly supplied and HSC 119308-Cross-contamination avoided during all accessible,warm water ❑ ❑ 30' hases of prociiidure ❑ ❑ 12. HSC 119306-Hepatitis B vaccination I BEST BUSINESS PRACTICES 13. HSC 119307-Bloodbome Pathogen training ❑ 31. HSC 119314-Areas separated/no living or sleeping quarters ❑ ❑ Source: ❑ 32' HSC 119314-Floors and walls clean and in good repair, ® adequate light ❑ HSC 119308 Appropriate personal protective equipment HSC 119314-Workstation,surfaces,including chairs, El 14. available and-used El ® 33' armrests,etc.in cod repair Cl CUSTOMERS/CLIENTS ❑ 34. HSC 119312-Permittregistration posted ❑ ❑ 15 HSC 119309-Branding is completed with no other HSC 119313-Operation and employee training records customers in procedure area El ® 35. resent ❑ HSC 119302-Customers eighteen(18)years of age or ❑ i6. older ❑ COMPLIANCE AND ENFORCEMENT ❑ 17. HSC 119308-Skin adequately prepared for procedure ❑ ❑ 36. HSC 119312-Plan(s)submitted for review ❑ ® 18 HSC 119303-Client records approved and available- ❑ Consent form and questionnaire ❑ ❑ 37. HSC 119312-Permits obtained and available HSC 119303, 119308-Appropriate aftercare instructions ® 79' given to client ❑ ❑ 38. HSC 119319-Impoundment ❑ MACHINE SAFETY AND SANITATION ❑ 39. HSC 119320-Hearing scheduled ❑ ❑ 20. HSC 119311 -Safe machine design ❑ ❑ 40. HSC 119312, 119317, 119320-Closure ❑ ❑ 21 HSC 119311 -Machines cleaned and disinfected between ❑ ❑ 41. ❑ clients Received by(Print): Jesus Garibav Received by(Signature): EMAILED Phone:408-661-1295 Specialist(Print): Vicky Vang-Lee Specialist(Signature): kl V"-1 a Phone:209-616-3028 Reinspectlon on/about: A minspection fee of$172 per hour may be charged. Page 1 of 3 EH-11/17