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i 9. The above facility is inspected for compliance with Division V = Violation 104, f Body Art Inspecl* Report Date: 577/1_5 V San Joaquin County Environmental Health Department Program V MACHINE SAFETY AND SANITATION (cont.) 1868 E. Hazelton Ave., Stockton, CA 95205 Record: Cj� y 13 \P.. tiFaR� (209) 468-3420 www.siogv.org/ehd Program Element: 22 Parts replaced between clients - grommets, elastic bands, etc. Eltest ❑ 2' Facility Name Address City Zip Code In 2 Skin Tattoo 2738 pacific ave Stockton 95204 Name of Permit/Registration Holder Permit Exp. Date Time In Time Out Inspection Type Sandy Aguirre 6/30/15 Routine 9. The above facility is inspected for compliance with Division V = Violation 104, ® Part 15, C = Chapter 7 of California Health and Safety Code (HSC). Corrected On Site ❑ V CLEANING AND STERILIZATION C V MACHINE SAFETY AND SANITATION (cont.) C ❑ 1 Autoclave: approved and effective - passed integrator ❑ ❑ 22 Parts replaced between clients - grommets, elastic bands, etc. Eltest ❑ 2' Items washed, disinfected, packaged, labeled, and sterilized ❑I appropriately❑ PREVENTING 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 18. PRACTITIONER HEALTH AND HYGIENE ❑ 9. No eating, drinking or smoking - clean clothes ❑ ® 5• Decontamination/sanitation area separated and supplied ❑ ❑ 11 appropriately ❑ ❑ 6 Invoices and log kept for disposable, pre -sterilized ❑ ❑ 13. equipment El ❑ 7 Sharps containers labeled, used, and disposed of ❑ ❑ 14. appropriately❑ ❑ ❑ 8 Jewelry, tattoo and piercing equipment - clean and ❑ 15. Branding is completed with no other customers in procedure area sterilized ❑ PRACTITIONER HEALTH AND HYGIENE ❑ 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 ❑ 29. Source: Cathie Montie, Body Art Training Group ❑ ❑ 14. Appropriate personal protective equipment available and used ❑ CUSTOMERS/CLIENTS El 15. Branding is completed with no other customers in procedure area ❑ ❑ 16. Customers eighteen (18) years of age or older ❑ ❑ 17. Skin adequately prepared for procedure ❑ ❑ 18. Client records approved and available - Consent form questionnaire Eland ❑ 19. Appropriate aftercare instructions given to client ❑ MACHINE SAFETY AND SANITATION ❑ 20. Safe machine design ❑ 21. Machines cleaned and disinfected between clients Chemical used: Cavicide ❑ 25. Disinfectant used appropriately/sufficient contact time ❑ ❑ 32. [Wet contact time provided: 3-5 mins ❑ ❑ 26. Barriers used ❑ F] 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 ❑ ❑ 30. Cross -contamination avoided during all phases of procedure ❑ BEST BUSINESS PRACTICES ❑ 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 good repair ❑ ® 34. Perm it/registration posted ❑ ® 35. Operation and employee training records present ❑ COMPLIANCE AND ENFORCEMENT ❑ 36. Plan(s) submitted for review ❑ ❑ 37. Permits obtained and available ❑ ❑ 38. Impoundment ❑ ❑ 39. Hearing scheduled ❑ ❑ 40. Closure ❑ ® 41. Proper disposal of razors ❑ Received b (Print): Chris De Voss Received by (Signature): ✓`'"'-Phone: 209 464-9774 Specialist (Print): Hamrit Mattu. Sr REHS Specialist (Signature): A&ZIA Phone: (209) 468-3284 Reinspecion on/about: A reinspection fee of $130 per hour may be charged. Page 1 of 2 EH -03/2015