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ouiN' Date(MM/DD/YY) . 3 oo Body Art Inspection Report r� y County of San Joaquin County,Environmental Health Department P�47 S3'71 Sv 11 c 1868 E.Hazelton Ave.,Stockton CA 95205 Permit Number 1'. (209)468-3420 mvw.sigov.orq/ehd a�- Permit Type Facility Name Address City Zip Code CT Permit/Registration Holder Name Permit Exp.Date Total Time Ins ectio Type RISK FACTORS AND INTERVENTIONS Risk factors are improper practices or procedures identified as contributing factors of cross-contamination. Interventions are control measures to prevent cross-contamination and transfer of pathogens from one person to another. In=In Compliance Out=Not in Compliance NIO=Not Observed NIA=Not Applicable COS=Corrected On Site 'Qka * lis. v r" �t�;TAUOrA ID PERMANENT�COSMETICS MACHINE ¢..' CLEANINGsAND,STEf21LIZATIt)NA= '` otir "cos' . ,t :SAFETYAND SANITATION ii; t - ourcos In N/0 1. Autoclave is approved and effective-passedIn N10 18. Safe machine design N/A integrator test El N/A El ❑ In N/0 2. Process of cleaning,labeling,packaging and ElI NIO 19. Machines cleaned and disinfected between114 ❑ ❑ N/ sterliziing items correct) /A clients In N/ 3. Autoclave loaded correctly/packages allowed to ❑ E] In 10 20. Parts replaced between clients-grommets,-IN ❑ ❑ / dry A elastic bands,etc. In N10 4. Integrators used/monthly spore test/log .i FSE NTING CROS&CONTAMINATION,'� { ❑ ❑ ti f ;bra^a t IA maintained I N/0 5. Decontamination/sanitation area separate and ❑ ❑ In N/0 21. Workstation/procedure area decontaminated ❑ ❑ N/A supplied* N/A In NIO 6. Invoices and log kept for disposable,pre- 14 ❑ N/O 22. Chemical disinfectant used El 11 NIA sterilized equipment,backupsupplies available* /A Chemical used: Mud In N/O 7. Sharps containers supplied,labeled,used and ❑ ❑ In !0 23. Disinfectant used sufficient,contact time Wet ❑ NIA disposed of correctly /A contact time provided: e k I In N/0 8. Jewelry,tattoo and piercing equipment-storage ❑ N/0 24. Barriers available and used as part of ❑ ❑ NIA and use /A procedure Kaa. N10 25. Products applied to skin are single .. <PRACTITIONER HEALTH`AND HYGIENE N/A use/dis nsed ase tical) El ❑ N10 9. No eating,drinking or smoking-clean clothes ❑ ❑ n N/0 26. Storage of inks,pigments,needles,tubes,etc., ❑ ❑ /A !A In N/O 10. Hands washed effectively and timely ❑ ❑ In N/O 27. Jewelry,Inks,Needles etc approved and used ❑ N/A /A In N/0 11. Handwashing facilities properly supplied and ❑ I NIO 28. Cross-contamination avoided during all phases ❑ ❑ NIA accessible,warm potable water* N/A of procedure NIO 12. Personal protective equipment available and 'BEST BUSINESS PRA0IICESi r /A used,eyewash station available* 11 ❑ kY `" . , ' N/0 29. Areas separated/no living or sleeping 9 CUS OMERSICLfEQ ❑ ❑ +t } a, :.�. /Aquarters/no animals In NIO 13. Branding is completed with no other customers in '] ❑ In NIO 30. Floors and walls clean and in good repair, El/CT/ procedure area N/A ade uate li ht n 10 14. Customers eighteen(18)years of age or older ❑ 13In NIO 31. Workstation,surfaces,including chairs,,etc.in ❑ N/A NIA I good repair;trash removed frequently* In N/0 15. Skin prepared for procedure. ❑ n 10 32. Permit/registration and required signs posted* ❑ ❑ /A /A In N/0 16. Client records available-Consent form& ❑ In N/O 33. IPCP and employee training records and K ❑ N/A questionnaire /A He atitiis B vaccination status present In N/0 17. Aftercare instructions given to client11M/A N/0 34 Restrooms available,stocked* ❑ 11N/A Received by(Print): sce le P Received by(Signature): Phone: Specialist(Print): Specialist(Signature): Phone: ❑ This report is an Official Notice of Violation.Corrections must be completed in the time specified. A reinspection fee may be charged if violations noted on this report are not corrected by the reinspection date. Reinspection Date(on or about) Pagel of 3