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is Body Art Inspects Report 0 Date: 6.tT I San Joaquin County Environmental Health Department Program 1868 E. Hazelton Ave., Stockton, CA 95205 Record: (209)468-3420 • c <IFiiR`'�P • www.siogv.orq/ehd Program Element: Facility Name Address City Zip Code In 2 Skin 2738 pacific ave Stockton 95204 Name of Permit/Registration Holder Permit Exp. Date Time In Time Out Inspection Type Sandy Aguirre 6/30/14 Routine The above facility is inspected for compliance with Division 104, Part 15, Chapter 7 of California Health and Safety Code (HSC). V = Vinlafinn C = r..nrrPntarl On Sita V CLEANING AND STERILIZATION C V I MACHINE SAFETY AND SANITATION cont. C ❑ 1 Autoclave: approved and effective - passed integrator ❑ ❑ 22 Parts replaced between clients - grommets, elastic bands, etc. Eltest El 2. Items washed, disinfected, packaged, labeled, and sterilized El CROSS -CONTAMINATION ❑ 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 ❑ ®1 5• Decontamination/sanitation area separated and supplied appropriately ❑ Chemical used: ® 6. Invoices and log kept for disposable, pre -sterilized equipment El 25. Disinfectant used appropriately/sufficient contact time ElSharps ® 7' containers labeled, used, and disposed of ro riatel appropriately ❑ Wet contact time provided: El El 8. 8' Jewelry, tattoo and piercing equipment - clean and ❑ ® 26. Barriers used Elsterilized PRACTITIONER HEALTH AND HYGIENE El 27' Products applied to skin are single use/dispensed ase tical) ❑ ❑ 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, warm water ❑ ❑ 30. Cross -contamination avoided during all phases of rocedure ❑ ❑ 12. Hepatitis B vaccination ❑ BEST BUSINESS 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 ❑ ❑ 14. Appropriate personal protective equipment available and ❑ 33 Workstation, surfaces, including chairs, armrests, etc. in repair Elusedgood CUSTOMERS/CLIENTS ❑ 34. Perm it/registration posted ❑ El 15. Branding is completed with no other customers in procedure area El El35. Operation and employee training records present ❑ ❑ 16. Customers eighteen (18) years of age or older ❑ COMPLIANCE AND ENFORCEMENT ❑ 17. Skin adequately prepared for procedure ❑ ❑ 36. Plan(s) submitted for review ❑ ® 18 Client records approved and available - Consent form and questionnaire ❑ ❑ 37. Permits obtained and available ❑ ® 19. Appropriate aftercare instructions given to client ❑ ❑ 38. Impoundment ❑ MACHINE SAFETY AND SANITATION ❑ 39. Hearing scheduled ❑ ❑ 20. Safe machine design ❑ ❑ 40. Closure ❑ ❑ 21. Machines cleaned and disinfected between clients ❑ I ❑ 41. ❑ Received b (Print): /y, fte1C.-t Received by (Signature): Phone: Specialist (Print): Afonso Arambula Specialist (Signature): Phone: (209) 468-9673 Reinspecion onlabout: A reinspection fee of $125 per hour EH -04/2014 Page 1 of 3