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Body Art Inspection Report Date: N g San Joaquin County Environmental Health Department Program 1868 E. Hazelton Ave., Stockton, CA 95205 Record: c (209) 468-3420 Program w1/ www.slogv.org/ehd Element: Facility Name Address City Zip Code Aesthetics Lash Ink 1955 lucile ave. ste b Stockton 95209 Name of Permit/Registration Holder Permit Exp. Date Time In Time Out Inspection Type Carrie Blubaugh 6/30/21 Routine The above 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 MACHINE SAFETY AND SANITATION (cont.) C ❑ 1 Autoclave: approved and effective - passed integrator ❑ ❑ 22 Parts replaced between clients - grommets, elastic bands, Eltest etc. El 2' Items washed, disinfected, packaged , labeled, and sterilized ❑ PREVENTING CROSS-CONTAMINATION ❑ 3. Autoclave loaded correctly/packages allowed to dry ❑ ❑ 23. Workstation/procedure area decontaminated ❑ ❑ 4. Integrators used/monthly spore test/log maintained ❑ ❑ 24. Appropriate chemical disinfectant used Decontamination/sanitation area separated and supplied ❑ ❑ 5' appropriately El Chemical used: ® Invoices and log kept for disposable, pre-sterilized 6' equipment El El25. Disinfectant used appropriately/sufficient contact time ElSharps containers labeled, used, and disposed of ❑ 7. appropriately ❑ Wet contact time provided : ❑ 8 Jewelry, tattoo and piercing equipment - clean and El El 26. Barriers used Elsterilized Products applied to skin are single use/dispensed PRACTITIONER HEALTH AND HYGIENE ❑ 27' asepticallyEl ❑ 9. No eating, drinking or smoking - clean clothes ❑ ❑ 28. Storage of inks, pigments, needles, tubes, etc. ❑ ❑ 10. Hands washed effectively and timely ❑ ❑ 29. Jewelry, Inks, Needles etc approved and used correctly ❑ El it . Handwashing facilities properly supplied and accessible, Cross-contamination avoided during all phases of warm water Ell ❑ 30' procedure ❑ ❑ 12. Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES ❑ 13. Bloodborne Pathogen trainingElElEl31 . Areas separated/no living or sleeping quarters Source: ❑ 32. Floors and walls clean and in good repair, adequate light ❑ ❑ 14. Appropriate personal protective equipment available andEl ❑ 33 Workstation., surfaces, including chairs, armrests, etc. in Elused good repair CUSTOMERS/CLIENTS ❑ 34. Permit/registration posted ❑ Branding is completed with no other customers in El 15. rocedure area ❑ El 35. Operation and employee training records present ❑ ❑ 16. Customers eighteen (18) years of age or older ❑ COMPLIANCE AND ENFORCEMENT ❑ 17. Skin adequately prepared for procedure ❑ ❑ 36. Plan(s) submitted for review ❑ ® Client records approved and available - Consent form 18. El 37. Permits obtained and available Eland questionnaire ❑ 19. Appropriate aftercare instructions given to client ❑ ❑ 38. Impoundment ❑ MACHINE SAFETY AND SANITATION ❑ 39. Hearing scheduled ❑ ❑ 20. Safe machine design ❑ ❑ 40. Closure ❑ ❑ 21 . Machines cleaned and disinfected between clients ❑ ❑ 41 . ❑ Received by (Print): Carrie Blubaugh Received by (Signature): Phone: 209-251 -9452 Specialist (Print): Sandip Singh Specialist (Signature): Phone: 209-468-3526 Reinspecion onlabout: A reinspection fee of $152 per hour may be charged. Page 1 of 2 EH-11/17