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eo Body Art Inspeck Report it Date: r <iSan Joaquin County Environmental Health Department Program 1868 E. Hazelton Ave., Stockton, CA 95205 Record: (209) 468-3420 Program www.siogv.or4/ehd Element: LA/a 1 /t S Pfl- sa83 8.2 4121 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 6/30/15 Routine The above facility is inspected for compliance with Division V = Violation 104, Part 15, C = Chapter 7 of California Health and Safety Code (HSC). 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 El CROSS -CONTAMINATION ❑ 3. Autoclave loaded correctly/packages allowed to dry [:1 ❑ 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 E]Chemical I used: ® 6' Invoices and log kept for disposable, pre -sterilized equipment ❑ ❑ 25. Disinfectant used appropriately/sufficient contact time ❑ ® 7 Sharps containers labeled, used, and disposed of appropriately ❑ Wet contact time provided: ® 8' Jewelry, tattoo and piercing equipment - clean and sterilized ❑ ❑ 26. Barriers used ❑ PRACTITIONER HEALTH AND HYGIENE ❑ 27' Products applied to skin are single use/dispensed 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 ❑ ® 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 El CUSTOMERS/CLIENTS ® 34. Permit/registration posted ❑ El 15. Branding is completed with no other customers in rocedure area ❑ ® 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 ❑ ® 18 Client records approved and available - Consent form i ❑ El 37. Permits obtained and available Elanduestionnare ® 19. Appropriate aftercare instructions given to client ❑ ❑ 38. Impoundment ❑ MACHINE SAFETY AND SANITATION ❑ 39. Hearing scheduled ❑ ❑ 20. Safe machine design ❑ ❑ 40. Closure ❑ r[IT21 Machines cleaned and disinfected between clients ❑ ❑ 41. ❑ Received Received Specialist (Print): Beniamin Escotto, Sr REHS Specialist (Signature): Phone: (209) 468-3178 Reinspecion on/about: `J ��-1 �� S A reinspection fee of $130 per hour may be charged. EH -03/2015 Page 1 of 3 I