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Body Art Ins ectlt Report <br /> Date: <br /> San Joaquin County Environmental Health Department Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: 1?RO 6:5 7378 <br /> (209)468-3420 Program <br /> ` www.sioov.oro/ehd Element: 1-/1. <br /> Facility Name Address City Zip Code <br /> Wicked Wayz 920 s cherokee In#a Lodi 95240 <br /> Name of Permit/Registration Holder Permit Exp. Date Time In Time Out Inspection Type <br /> Mohamed Abdullah 6/30/20 Routine <br /> The above facility is inspected for compliance with Division 104,Part 15,Chapter 7 of California Health and Safety Code(HSC). <br /> V=Violation C=Corrected On Site <br /> MUM i <br /> ❑ 1 Autoclave:approved and effective-passed integrator ❑ El22 Parts replaced between clients-grommets,elastic bands, Eltest etc. <br /> Items washed,disinfected, packaged,labeled,and <br /> El2. sterilized ❑ <br /> ❑ 3. Autoclave loaded correctly/packages allowed to dry ❑ ❑ 23. Workstation/procedure area decontaminated ❑ <br /> ® 4. Integrators used/monthly spore test/log maintained ❑ [1 24. Appropriate chemical disinfectant used <br /> Decontamination/sanitation area separated and supplied El❑ 5. a ro riatel El Chemical used: <br /> Invoices and log kept for disposable, pre-sterilized <br /> El 6' ❑ El 25. Disinfectant used appropriately/sufficient contact time <br /> equipment <br /> ElSharps containers labeled, used,and disposed of <br /> ❑ 7' Elappropriately <br /> [Wet contact time provided: <br /> ❑ <br /> Jewelry,tattoo and piercing equipment-clean and 8. ❑ El 26. Barriers used <br /> sterilized <br /> Products applied to skin are single use/dispensed <br /> El 27. asepticallyE] <br /> ❑110.910. <br /> No eating,drinking or smoking-clean clothes El ❑ 28. Storage of inks, pigments, needles,tubes,etc. E]❑ Hands washed effectively and timely El El29. Jewelry, Inks, Needles etc approved and used correctly El <br /> Handwashing facilities properly supplied and accessible, Cross-contamination avoided during all phases of <br /> El 11. warm water ❑ ❑ 30' procedure E] <br /> ❑ 12. Hepatitis B vaccination ❑ r <br /> ❑ 13. Bloodborne Pathogen training ❑ 31. Areas separated/no living or sleeping quarters ❑ <br /> Source: ❑ 32. Floors and walls clean and in good repair,adequate light ❑ <br /> ❑ <br /> Appropriate personal protective equipment available and Workstation,surfaces, including chairs,armrests,etc. in 14. used E:1 ❑ 33' good repair E] <br /> MIEl34. Permit registration posted El <br /> 7Bra7nding is completed with no other customers in <br /> ❑ e area ❑ ® 35. Operation and employee training records presentrs eighteen(18)years of age or older ❑ <br /> ❑ 17. Skin adequately prepared for procedure ❑ ❑ 36. Plan(s)submitted for review ❑ <br /> Client records approved and available-Consent form <br /> El 18. questionnaire El [j37. Permits obtained and available Eland <br /> ❑ 19. Appropriate aftercare instructions given to client ❑ ❑ 38. Impoundment ❑ <br /> 11 N W"FIRRM 11, ❑ 39. Hearing scheduled ❑ <br /> ❑ 20. Safe machine design ❑ ❑ 40. Closure ❑ <br /> ❑ 21. Machines cleaned and disinfected between clients ❑ ❑ 41. ❑ <br /> Received b (Print): E Received b (Signature): Phone: <br /> Specialist(Print): Sandip Singh Specialist(Signature): &11 <br /> _ Phone: 209-468-3526 <br /> Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Page 1 of 2 <br /> EH-11/17 <br />