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U"" y rt Body AInsr port J&n Re Date: k= San Joaquin County Environmental Health Department Program 2 1868 E. Hazelton Ave., Stockton, CA 95205 Record: (209) 468-3420 Program 4<'ikoRia� www.siogv.org/end 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 6/30118 Routine The above facility is inspected for compliance with Division 104, Part 15, Chapter 7 of California Health and Safety Code (HSC). V = \/inlatinn C = r'.nrrP.CtPd r)n Sita V CLEANING AND STERILIZATION C V MACHINE SAFETY AND SANITATION cont. ❑ 1 Autoclave: approved and effective - passed integrator ❑ ❑ 22 Parts replaced between clients - grommets, elastic bands, test etc. ® 2' Items washed, disinfected, packaged, labeled, and El sterilized 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 ❑ 5' Decontamination/sanitation area separated and supplied ro Chemical used: Cavicide a ro riatel ® 6. Invoices and log kept for disposable, pre -sterilized ❑ 25. Disinfectant used appropriately/sufficient contact time a ui ment ® 7' Sharps containers labeled, used, and disposed of El [Wet contact time provided: 10 min a ropriatel ® 8. Jewelry, tattoo and piercing equipment - clean and El El26. Barriers used sterilized ❑ 27 I Products applied to skin are single use/dispensed PRACTITIONER HEALTH AND HYGIENE aseptically ❑ 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, El ❑ 30. Cross -contamination avoided during all phases of warm water procedure ® 12. Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES ® 13. Bloodborne Pathogen training 31. Areas separated/no living or sleeping quarters ❑ Source: Cathy Montie 32. Floors and walls clean and in good repair, adequate light ❑ 14. Appropriate personal protective equipment available and El El ro 33. Workstation, surfaces, including chairs, armrests, etc. in used ood repair 34. Perm it/registration posted CUSTOMERS/CLIENTS ❑ 15. Branding is completed with no other customers in ❑ ® 35. Operation and employee training records present procedure area ❑ 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 ❑ ❑ 37. Permits obtained and available and questionnaire ❑ 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 ❑ ❑ 41. j e Received b (Print): Chris De Voss Received b Si nature :l% ` V Phone: 209 464-9774 Specialist (Print): Nav'ot Sahota Specialist Si nature : Phone: 209 468-3178 Reinspecion on/about: A reinspection fee of $152 per hour may be charged. Page 1 of EH -11/17 C