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e�Qa `P + BodyArt Ins ecok Report P P is San Joaquin County Environmental Health Department 1868 E. Hazelton Ave., Stockton, CA 95205 (209) 468-3420 www.smoclv.org/ehd Date: Program Record: Program Element: _114-0 1 ��j*7 2 g ]I3 (, 2A _`L• ❑ 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 Kashmir Dhanoya 6/30/18 Autoclave loaded correctly/packages allowed to dry Re -inspection 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 ❑ 1 Autoclave: approved and effective - passed integrator ❑ ❑ 10. test ❑ ® 2. Items washed, disinfected, packaged, labeled, and ❑ ❑ 12. sterilized ❑ ❑ 3. Autoclave loaded correctly/packages allowed to dry ❑ ❑ 4. Integrators used/monthly spore test/log maintained ❑ ® 5' Decontamination/sanitation area separated and supplied ❑ 19. Appropriate aftercare instructions given to client a pro riatel ❑ ❑ 6 Invoices and log kept for disposable, pre -sterilized ❑ El ❑ equipment ❑ ❑ 7' Sharps containers labeled, used, and disposed of El approDriatelv ❑ 8 Jewelry, tattoo and piercing equipment - clean and ❑ sterilized ❑ 9. No eating, drinking or smoking - clean clothes ❑ ❑ 10. Hands washed effectively and timely ❑ ® 11. Handwashing facilities properly supplied and accessible, warm water ❑ ❑ 12. Hepatitis B vaccination ❑ ® 13. Bloodborne Pathogen training El 18. Client records approved and available - Consent form Source: ❑ ❑ 14. Appropriate personal protective equipment available and used ❑ Y MACHINE SAFETY AND SANITATION (cant) ❑ 22 Parts replaced between clients - grommets, elastic bands, ❑ ❑ `GUSTOMERSlC E.NTS Workstation/procedure area decontaminated El 15. Branding is completed with no other customers in E] ❑ ❑ procedure area Chemical used: Cavacide ❑ 16. Customers eighteen (18) years of age or older ❑ ❑ 17. Skin adequately prepared for procedure ❑ ® 18. Client records approved and available - Consent form E]and ❑ El questionnaire ❑ 19. Appropriate aftercare instructions given to client ❑ ❑ Rw.. 29. Jewelry, Inks, Needles etc approved and used correctly NID I ZINE S tFET AWSAkrMT14N, El ❑ 20. Safe machine design ❑ ❑ 21. Machines cleaned and disinfected between clients ❑ Y MACHINE SAFETY AND SANITATION (cant) ❑ 22 Parts replaced between clients - grommets, elastic bands, ❑ ❑ 23. Workstation/procedure area decontaminated ❑ ❑ 24. Appropriate chemical disinfectant used ❑ ❑ 32. Chemical used: Cavacide El ❑ 25. Disinfectant used appropriately/sufficient contact time ❑ ❑ 40. [Wet contact time provided: 5-10 mins ❑ ❑ 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 pro El ... A ::. oc.��aovan�c.�.� rrv�.�Crrw�.�:-x.,•,- .„ah: -s. . �,.. _.... ❑ 31. Areas separated/no living or sleeping quarters ❑ ❑ 32. Floors and walls clean and in good repair, adequate light ❑ ❑ 33. Workstation, surfaces, including chairs, armrests, etc. in ❑ ❑ 40. good repair ❑ ❑ 34. Permit/registration posted ❑ ® 35. Operation and employee training records present ❑ %CoMPUANCE AND ENFORCEMEN ❑ 36. Plan(s) submitted for review ❑ ❑ 37. Permits obtained and available ❑ ❑ 38. Impoundment ❑ ❑ 39. Hearing scheduled ❑ ❑ 40. Closure ❑ ❑ 41. ❑ Received b (Print): Aman Dhano a Received by (Signature): !MY` l Phone: 209 637-9764 Specialist (Print): Har rit Mattu, Sr REHS Specialist (Signature): AXA47 Phone: 209 468-3284 Reinspecion on/about: A reinspection fee of $130 per hour may be charged. Page 1 of 2 EH -03/2015