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;1 Body Art InsWt4weport Date: �1 f-1 San Joaquin County Environmental Health Department Items washed, disinfected, packaged, labeled, and Elsterilized I 1868 E. Hazelton Ave., Stockton, CA 95205 Program ' PR 5 Z ❑ 468-3420 Record: ❑ p(' _ (209) MLj sioay.org/ehd Program Element: t✓ l / Z Facility Name Address City Zip Code Blue Moon Tattoo/Piercing 2306 east street Tracy 95376 Name of Permit/Registration Holder Permit Exp. Date Time In Time Out Inspection Type Dhanoya, Amanjit 6/30/19 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, ❑ PRACTITIONER HEALTH AND HYGIENE ❑ 1 9. test ❑ f-1 2' Items washed, disinfected, packaged, labeled, and Elsterilized ❑ 11 Handwashing facilities property supplied and accessible, warm water ❑ 3. Autoclave loaded correctly/packages allowed to dry ❑ ® 4. Integrators used/monthly spore test/log maintained ❑ El 5. Decontamination/sanitation area separated and supplied ❑ ❑ 14. appropriately ❑ ® 6 Invoices and log kept for disposable, pre -sterilized ❑ ❑ 29. equipment ❑ ® 7• Sharps containers labeled, used, and disposed of ❑ appropriately ❑ 8 Jewelry, tattoo and piercing equipment - clean and ❑ PRACTITIONER HEALTH AND HYGIENE ❑ 1 9. No eating, drinking or smoking - clean clothes ❑ ❑ 10. Hands washed effectively and timely ❑ ❑ 11 Handwashing facilities property supplied and accessible, warm water ❑ ❑ 12. Hepatitis B vaccination ❑ ❑ 13. Bloodborne Pathogen training El ❑ 26. Source: ❑ ❑ 14. Appropriate personal protective equipment available and ❑ ❑ 15. Branding is completed with no other customers in procedure area ❑ ❑ 16. Customers eighteen (18) years of age or older ❑ ❑ 17. Skin adequately prepared for procedure ❑ ® 18. Client records approved and available - Consent form and questionnaire El ❑ 19. Appropriate aftercare instructions given to client ❑ MACHINE SAFETY AND SANITATION ❑ 20. Safe machine design ❑ 21. Machines cleaned and disinfected between clients PREVENTING CROSS -CONTAMINATION ❑ 23. Workstation/procedure area decontaminated ❑ ❑ 24. Appropriate chemical disinfectant used ❑ El 33. Chemical used: f-1 ❑ 25. Disinfectant used appropriately/sufficient contact time El ® 35. Wet contact time provided: ❑ ❑ 26. Barriers used ❑ El 27. Products applied to skin are single use/dispensed El ❑ 28. Storage of inks, pigments, needles, tubes, etc. ❑ ❑ 29. Jewelry, Inks, Needles etc approved and used correctly ❑ El 30. Cross -contamination avoided during all phases of BEST BUSINESS PRACTICES ❑ 31. Areas separated/no living or sleeping quarters ❑ ❑ 32. Floors and walls clean and in good repair, adequate light ❑ El 33. Workstation, surfaces, including chairs, armrests, etc. in good repair f-1 ❑ 34. Permit/registration posted ❑ ® 35. Operation and employee training records present ❑ COMPLIANCE AND ENFORCEMENT ❑ 36. Plan(s) submitted for review ❑ ❑ 37. Permits obtained and available ❑ ❑ 38. Impoundment ❑ ❑ 39. Hearing scheduled ❑ ❑ 40. Closure ❑ ❑ 41. ❑ Received by (Print): �M('A� 1 t-�p- GY�CjV(� Received by (Signature): L`vuf Phone: .loy- 63.7 - 1,? Iy Snerialict (Prinfi- . )s'J C 7/ �n Soecialist (Signature): r Phone: &q - q,53 - j � 16 Reinspecion on/about: A reinspection fee of $152 per hour may be charged. Page 1 of 3 EH -11 /17 ' (2) 1,