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Body Art Inspect& Report Date: SI�SI1�1 <br /> z <br /> San Joaquin County Environmental Health Department Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: PQ 053'1 S3� <br /> (209)468-3420 <br /> •'c4<,Fok�`' wwwsiogv.org/ehd Program <br /> Element: 4�Z <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 /> Ebrihimi Razer 6/30/14 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 cont. C <br /> ® 1 Autoclave:approved and effective-passed integrator ❑ ❑ 22 Parts replaced between clients-grommets,elastic bands, Eltest etc. <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 /> ® & appropriately ❑ Chemical used: <br /> Invoices and log kept for disposable,pre-sterilized <br /> El 6' equipment ❑ E] 25. Disinfectant used appropriately/sufficient contact time <br /> Sharps containers labeled,used,and disposed of ❑ <br /> ® 7' E]appropriately <br /> [Wet contact time provided: <br /> Jewelry,tattoo and piercing equipment-clean and <br /> ❑ 8. El 26. Barriers used <br /> sterilized ❑ <br /> Products applied to skin are single use/dispensed <br /> PRACTITIONER HEALTH AND HYGIENE ❑ 27' asepticallyEl <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 /> Handwashing facilities properly supplied and accessible,® Cross-contamination avoided during all phases of 11' warm water ❑ El 30' procedure E] <br /> ❑ 12. Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES <br /> ® 13. Bloodborne Pathogen training ❑ 31. Areas separated/no living or sleeping quarters ❑ <br /> Source: ® 32. Floors and walls clean and in good repair,adequate light ❑ <br /> Appropriate personal protective equipment available and Workstation,surfaces,including chairs,armrests,etc.in <br /> ❑ 14. used [I ❑ 33' good repair E] <br /> CUSTOMERS/CLIENTS ® 34. Permit/registration posted ❑ <br /> Branding is completed with no other customers in <br /> El 15. rocedure area El ® 35. Operation and employee training records present ❑ <br /> ® 16. Customers eighteen(18)years of age or older ❑ COMPLIANCE AND ENFORCEMENT <br /> ❑ 17. Skin adequately prepared for procedure ❑ ro 36. Plan(s)submitted for reviewClient records approved and available-Consent form18. uestionnaire37. Permits obtained and available Eland19. Appropriate aftercare instructions given to client E] 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 b (Print): Ebrihimi Razer Received by(Signature): Phone: .� k <br /> Specialist(print): Benjamin Escotto Specialist Si nature: Phone: 209 468-3178 <br /> Reinspecion on/about: to�l(Q �IU A reinspection fee of$125 per hour may charged. Page 1 of 3 <br /> EH-04/2014 <br />