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BodyArt Ins ort ectoRe p p Date: San Joaquin County Environmental Health Department Program { 1868 E. Hazelton Ave., Stockton, CA 95205 Record: , \ P (209) 468-3420 Program I' n L I www_sioclv.org/ehd Element: 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 Y C6 EAIViNG ANDTERILIZATItJN" :r C,w Y.. MACk1„NE SAFEIYAND ❑ 1 Autoclave: approved and effective - passed integrator ❑ ❑ 22 Parts replaced between clients - grommets, elastic bands, E]test etc. ® 2. Items washed, disinfected, packaged, labeled, and ElRREVENTINI.CROSS -,c sterilized -CONTAI�AINATION ❑ 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 ❑ Chemical used: a propriatel [_1 6. Invoices and log kept for disposable, pre -sterilized F]❑ 25. Disinfectant used appropriately/sufficient contact time equipment ❑ [j 7' Sharps containers labeled, used, and disposed of ❑ Wet contact time provided: appropriatelyJewelry, ® 8. tattoo and piercing equipment - clean and El El 26. Barriers used sterilized ❑ 27. Products applied to skin are single use/dispensed PRACTITIONER AND F1f�NE ��,.. „. 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, ❑ ® 30. Cross -contamination avoided during all phases of ❑ warm water procedure ® 12. Hepatitis B vaccination ❑ x, tBE MSINES :.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 ❑ E] 14. Appropriate personal protective equipment available and El ❑ 33. Workstation, surfaces, including chairs, armrests, etc. in ❑ used good repair ® 34. Permit/registration posted ElRS/CLIENTS, CUSTOM v. ; .. ';. ;•,. ... El 15. Branding is completed with no other customers in El ® Operation and employee training records present El35. procedure area ❑ 16. Customers eighteen (18) years of age or older ❑ COMPLIANCEAND z ENt)RCEMEN, ❑ 17. Skin adequately prepared for procedure ❑ ❑ 36. Plan(,) submitted for review ❑ ® 18. Client records approved and available - Consent form El El 37. Permits obtained and available and questionnaire ❑ 19. Appropriate aftercare instructions given to client ❑ ❑ 38. Impoundment ❑ El39. Hearing scheduled ❑ MA,}i1NE SAFE .. ,AND'SANIT TION ,, ;, ,',. ❑ 20. Safe machine design ❑ ❑ 40. Closure ❑ ❑ 21. Machines cleaned and disinfected between clients ❑ ❑ 41. ❑ Received by (Print): MGM Received by (Signature): Phone: Specialist (Print):•6pg/� Specialist (Signature): Phone: 94;3 ^%�310 Reinspecion on/about: A reinspection fee of $152 per hour may be charged. Page 1 of 3 EH -11/17