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j44tM Body Art Inspec& Report • Date: �Il-7Report -7 (114 <br /> `. San Joaquin County Environmental Health Department <br /> Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: P2VSP S 3� <br /> p (209)468-3420 Program <br /> `? a` www slogv.orq/ehd U 1a <br /> Element: <br /> Facility Name Address City Zip Code <br /> Living Ink 2189 n tracy blvd Tracy 95376 <br /> Name of Permit/Registration Holder Permit Exp.Date Time In Time Out Inspection Type <br /> Razer Ebrihimi 6/30/14 Re-inspection <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,T'.arts replaced between clients-grommets,elastic bands, ❑ <br /> testec. <br /> Items washed,disinfected,packaged,labeled,and <br /> El 2' sterilized El CROSS-CONTAMINATION <br /> ❑ 3. Autoclave loaded correctly/packages allowed to dry ❑ ❑ 23. 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 ❑ <br /> El 5' ElChemical used: <br /> appropriately <br /> r_1 6. <br /> ro riatel <br /> Invoices and log kept for disposable,pre-sterilized <br /> r_1 6. equipment r_1 r_125. Disinfectant used appropriately/sufficient contact time <br /> ElSharps containers labeled, used,and disposed of <br /> ® 7. appropriately <br /> El [Wet contact time provided: <br /> Jewelry,tattoo and piercing equipment-clean and <br /> ❑ 8' ElE]❑ 26. Barriers used <br /> sterilized <br /> Products applied to skin are single use/dispensed <br /> PRACTITIONER HEALTH AND HYGIENE ® 27. asepticallyE] <br /> ❑ 9. No eating,drinking or smoking-clean clothes ❑ [1 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, <br /> Cross-contamination avoided during all phases of 11. warm water F1 ❑ 30. procedure <br /> E] <br /> ❑ 12. Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES <br /> ® 13. Bloodborne Pathogen training ❑ 31. Areas separated/no living or sleeping quarters ❑ <br /> El <br /> Source: ❑ 32. Floors and walls clean and in good repair,adequate light ❑ <br /> ❑ <br /> Appropriate personal protective equipment available and E] [__1 surfaces, including chairs,armrests,etc. in 14. used ❑ 33' good repair <br /> F1 <br /> CUSTOMERS/CLIENTS ❑ 34. Perm ittregistration posted ❑ <br /> ❑ <br /> Branding is completed with no other customers in 15. ❑ ® 35. Operation and employee training records present E]rocedure area <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. El El 37. Permits obtained and available F-1 <br /> and <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 ❑ I ❑ 1 41. ❑ <br /> Received b (Print): Israel Jacobs Received b (Signature. Phone: s-/2 br^,t) <br /> Specialist(Print): Benjamin Escotto Specialist Si nature : Phone: 209 468-3178 <br /> Reinspecion on/about: -11111114 A reinspection fee of$125 per hour may charged. Page 1 of 2 <br /> EH-04/2014 <br />