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Body Art Inspeceport Date: San Joaquin County Environmental Health Department Program :e 1868 E. Hazelton Ave., Stockton, CA 95205 Record: (209) 468-3420 Program www.siogv.org/ehd Element: L,)Z� Facility Name Address City Zip Code Blue Moon Tattoo/Piercing 2306 east st. Tracy 95376 Name of Permit/Registration Holder Permit Exp. Date Time In Time Out Inspection Type Angel Hashimi 6/30/16 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, etc. Eltest ® 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 ❑ ® 5. Decontamination/sanitation area separated and supplied appropriately ❑ Chemical used: ® 6 Invoices and log kept for disposable, pre -sterilized equipment El 25. Disinfectant used appropriately/sufficient contact time 117 ® Sharps containers labeled, used, and disposed of appropriately El Wet contact time provided: ® 8 Jewelry, tattoo and piercing equipment - clean and sterilized ❑ ❑ 26. Barriers used E] PRACTITIONER HEALTH AND HYGIENE ❑ 27 Products applied to skin are single use/dispensed aseptically ❑ ® 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 ❑ ❑ 11 Handwashing facilities properly supplied and accessible, warm water El ❑ 30' Cross -contamination avoided during all phases of procedure ❑ ® 12. Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES ® 13. Bloodborne Pathogen training ❑ ❑ 31. 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 and used ❑® 33 Workstation, surfaces, including chairs, armrests, etc. in good repair ❑ CUSTOMERS/CLIENTS ® 34. Permit/registration posted ❑ ❑ 15. Branding is completed with no other customers in procedure area El® 35. Operation and employee training records present El ❑ 16. Customers eighteen (18) years of age or older ❑ COMPLIANCE AND ENFORCEMENT ❑ 17. Skin adequately prepared for procedure ❑ ❑ 36. Plan(s) submitted for review ❑ ® 18 Client records approved and available - Consent form and uestionnaire ❑ El 37. Permits obtained and available ❑ ® 19. 1 Appropriate aftercare instructions given to client ❑ ❑ 38. Impoundment ❑ MACHINE SAFETY AND SANITATION ❑ 39. Hearing scheduled ❑ ❑ 20. Safe machine design❑ El40. Closure ❑ ❑ 21. Machines cleaned and between clients ❑ ® 41. Sterile Dressing ❑ ^disinfected c Received b (Print): Af1M1&^ ��t71n r^' Received by (Signature):/ - Specialist (Print): Benjamin Escotto, Sr REHS S ecialis(Signature): Si nature : Phone: 209 468-3178 41 Reinspecion on/about: A reinspection fee of $130 per hour may be charged. Page 1 of 3 EH -03/2015