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° Body Art Ins <br /> Report Date: <br /> San Joaquin County Environmental Health Department Program <br /> a. <br /> _ 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: <br /> (209)468-3420 <br /> c4t;F.aRi�`P• www.siogv.org/ehd Program <br /> Element: '-t a <br /> Facility Name Address City Zip Code <br /> Hard Luck Tattoo 7 n sacramento st Lodi 95240 <br /> Name of Permit/Registration Holder Permit Exp.Date Time In Time Out Inspection Type <br /> Bao T Nguyen 6/30/14 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 /> V CLEANING AND STERILIZATION C V MACHINE SAFETY AND SANITATION cont. C <br /> ® 1 Autoclave:approved and effective-passed integrator ❑ ❑ 22 Parts replaced between clients-grommets,elastic bands, E]test etc. <br /> Items washed,disinfected,packaged,labeled,and El <br /> El 2' sterilized PREVENTING CROSS-CONTAMINATION <br /> ❑ 3. Autoclave loaded correctly/packages allowed to dry ❑ ❑ 23. 1 Workstation/procedure area decontaminated ❑ <br /> ❑ 4. Integrators used/monthly spore test/log maintained ❑ ❑ 24. Appropriate chemical disinfectant used <br /> Decontamination/sanitation area separated and supplied El <br /> El 5. a ro riatel El Chemical used: Madacide <br /> ® <br /> Invoices and log kept for disposable,pre-sterilized 6. El El 25. Disinfectant used appropriately/sufficient contact time <br /> equipment <br /> ElSharps containers labeled,used,and disposed of <br /> ❑ 7 Ela <br /> appropriately <br /> [Wet contact time provided: 10 Minutes <br /> Jewelry,tattoo and piercing equipment-clean and <br /> El 8' El El 26. Barriers used E]sterilized <br /> Products applied to skin are single use/dispensed <br /> PRACTITIONER HEALTH AND HYGIENE ❑ 27' asepticallyEl <br /> ❑ 9. No eating,drinking or smoking-clean clothes ❑ ❑ 28. Storage of inks,pigments,needles,tubes,etc. ❑ <br /> ❑ 10. Hands washed effectively and timely ❑ ❑ 29. Jewelry,Inks,Needles etc approved and used correctly ❑ <br /> Handwashing facilities properly supplied and accessible, Cross-contamination avoided during all phases of <br /> El 11. warm water El ❑ 30. procedure ❑ <br /> ❑ 12. Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES <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 /> Appropriate personal protective equipment available and Workstation,surfaces,including chairs,armrests,etc.in <br /> El 14. used El ❑ 33. good repair ❑ <br /> CUSTOMERSICLIENTS ❑ 34. Permit/registration posted ❑ <br /> Branding is completed with no other customers in <br /> F1 15. rocedure area ❑ El 35. Operation and employee training records present ❑ <br /> ❑ 16. Customers eighteen(18)years of age or older ❑ COMPLIANCE AND ENFORCEMENT <br /> ❑ 17. Skin adequately prepared for procedure ❑ ❑ 36. Plan(s)submitted for review ❑ <br /> ® <br /> Client records approved and available-Consent form 18. i ❑ ❑ 37. Permits obtained and available <br /> and uestionnare ❑ <br /> ❑ 19. Appropriate aftercare instructions given to client ❑ ❑ 38. Impoundment ❑ <br /> MACHINE SAFETY AND SANITATION ❑ 39. Hearing scheduled ❑ <br /> ❑ 20. Safe machine design ❑ ❑ 40. Closure ❑ <br /> ❑ 21. Machines cleaned and disinfected between clients ❑ ❑ 41. �*-❑/ +r�r <br /> Received b (Print): Daniel Kraft Received by(Signature): Phone:/d `,3 <br /> Specialist(Print): Afonso Arambula Specialist(Signature): Phone: 209 468-9673 <br /> Reinspecion on/about: A reinspection fee of$125 per hour may char d. Page 1 of 2 <br /> EH-04/2014 <br />