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u`f <br />o "a` Body Art Inspection Report Date: June 17,2021 <br />w San Joaquin County Environmental Health Department Program <br />1868 E. Hazelton Ave., Stockton, CA 95205 Record: PR0537413 <br />(209)468-3420 <br />P' W .siogy.oro/ehd Program <br />0�'CrFOp� Element: 4121 <br />Facility Name Address City Zip Code <br />In 2 Skin 2738 Pacific Ave Stockton 95204 <br />Name of Permit/Registration Holder Permit Exp. Date Time In Time Out Inspection Type <br />Sandy Aguirre 6/30/21 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 (contj C <br />El1. Autoclave: approved and effective - passed integrator test [I E] 22.22. Parts replaced between clients -grommets, elastic bands, Eltc. <br />El 2' Items washed, disinfected, packaged, labeled, and <br />sterilized ❑ PREVENTING CROSS -CONTAMINATION <br />❑ 3. Autoclave loaded correctly/packages allowed to dry ❑ ❑ 23. Workslaflon/procedure area decontaminated ❑ <br />❑ 4. Integrators used/monthly spore testilog maintained ❑ 24. Appropriate chemical disinfectant used <br />Decontamination/sanitation area separated and supplied ❑ ❑ <br />❑ 5' appro riately ❑ Chemical used: <br />® 6 Invoices and log kept for disposable, pre -sterilized <br />equipment ❑El25. Disinfectant used appropriately/sufficient contact time El <br />containers labeled, used, and disposed of <br />® 7' appropriately ❑ Wet contact time provided: <br />❑ 8 Jewelry, tattoo and piercing equipment - clean and ❑ ❑ 26. Barriers used <br />sterilized ❑ <br />PRACTITIONER HEALTH AND HYGIENE ❑ 27. Products applied to skin are single use/dispensed aseptically ❑ <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 />❑ 11 Handwashing facilities properly supplied and accessible, <br />warm water [I El30. Cross -contamination avoided during all phases of procedure ❑ <br />❑ 12. Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES <br />® 13. Bloodbome Pathogen training El <br />31. Areas separated/no living or sleeping quarters El <br />Source: 0 32. Floors and walls clean and in good repair, adequate light ❑ <br />❑ 14 Appropriate personal prolective equipment available and Workstation, surfaces, including chairs, armrests, etc. in <br />used El ® 33, good repair ❑ <br />CUSTOMERSICLIENTS ® 34. Permittregistration posted ❑ <br />❑ 15 Branding is completed with no other customers in <br />rocedure area ❑ ® 35. Operation and employee training records present El <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 />® 18 Client records approved and available - Consent form and ❑ <br />❑ ® 37. Permits obtained and available <br />questionnaire <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. ❑ <br />Received by (Print): Phillip Vasquez Received by (Si nature): EMAILED Phone: 209-406-8852 <br />Specialist (Print): Sandip Singh Specialist (Signature): Phone: 209-468-3526 <br />Reinspection onlabout A reinspection fee of $152 per hour may be charged. Page 1 of 3 <br />EH -11/17 <br />