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# 0 ` oulN, o •-� Body Art Inspection Report Date(MM/DD/YY) 11100112. 2' County of San Joaquin County,Environmental Health Department �t 19 1868 E.Hazelton Ave.,Stockton CA 95205 Permit Number "1 (209)468-3420 www.siaov.oro/ehd —1 I Permit Type Facility Name Address City Zip Code CT L=,�r`�f,+, .�nlrt.. 111 N .�cutl�t �,1�►ul. 7cuc,� 9s3� L Sup. �dac�>A;,1 Permit/Regi ration Holder Name Permit Exp.Date Total Time Inspection Type cbri�irr�; 1��3U( 13 Z11��;u� RISK FACTORS AND INTERVENTIONS Risk factors are improper practices or procedures identified as contributing factors of cross-contamination. Interventions are control measures to prevent cross-contamination and transfer of pathogens from one person to another. In=In Compliance Out=Not in Compliance NIO=Not Observed N/A=Not Applicable COS=Corrected On Site „. TATTOO AND PERMANENT COSMETICS MACHINE CLEANING AND STERILIZATIO ., . ...�• cos ' �. '"SAFETYAND SANITATION our cos In 10 1. Autoclave is approved and effective-passed ❑ ❑ rin N/0 18. Safe machine design N/A integrator test N/A In N/O 2. Process of cleaning,labeling,packaging and N/0 19. Machines cleaned and disinfected between Iml ❑ NIA sterliziin items correct) NIA clients Iri NI 3. Autoclave loaded correctly/packages allowed to ❑ 0 10 20. Paris replaced between clients-grommets, 0 0 N d N/A elastic bands,etc. In NIO 4. Integrators used/monthly spore test/log13 S •G' ' N/A maintained In N/0 5. Decontamination/sanitation area separate and El 7N/O . Workstation/procedure area decontaminated 0 ❑ N/A supplied* In NIO 6. Invoices and log kept for disposable,pre- 0 . Chemical disinfectant used 0 ❑ N/A sterilized equipment,backupsupplies available* Chemical used: O i Ll' In N/0 7. Sharps containers supplied,labeled,used and ❑ . Disinfectant used sufficient contact time Wet 0 0 N/A disposed of correct) * contact time provided: In N/0 8. Jewelry,tattoo and pierci g e ui ent–storage , Barriers available and used as part of 91 11 NIA and use — (} procedure In N/0 25. Products applied to skin are single PRACTI 0 E I 4T GIENE NIA use/dispensed aseptically In NIO 9. No eating,drinking or smoking-clean clothes I N/O 26. Storage of inks,pigments,needles,tubes,etc., N/A 0 11 /A 11 Ell In NIO 10. Hands washed effectively and timely ❑ NIA=,, 27. Jewelry,Inks,Needles etc approved and used 0 11 N/A In N/0 11. Handwashing facilities properly supplied and In W 28. Cross-contamination avoided during all phases IA accessible,warm potable water* NIA of procedure In Nl0 12. Personal protective equipment available and �.� BAST . - a: NIA I used,eyewash station available" O $CL QTS. In NIO 29. Areas separated/no living or sleeping E3 El /Aquarters/no animals In WJO 13. Branding is completed with no other customers in In N/0 30. Floors and walls clean and in good repair, 0 ❑ NIA procedure area 0 11 IA adequate light (JI N/0 14. Customers eighteen(18)years of age or older ❑ 0 I N/0 31. Workstation,surfaces,including chairs,,etc.in ❑ 13 N/ NIA good repair;trash removed fre uentl InNl0 15. Skin prepared for procedure. 0 17 In N/0 32. Permit/regitratio(�-and recd it signs posted* N/ N/A mo .0J1 e-:). In N/0 16. Client records available-Consent form& In NIO 33. IPCP and employee training records an 14 El N/A questionnaire N/A Hepatitis B vaccination status present In N/O 17. Aftercare instructions given to client 1pa EI In N/0 34 Restrooms available,stocked NIA N/A Received by(Print): �� t o Received by(Signature): Phone: Specialist(Print): �T Specialist(Signature): Phone: This report is an Official Notice of Violation.Corrections must be completed in the time specified. A reinspection fee may be charged if violations noted on this report are not corrected by the reinspection date. Reinspection Date(on or about) Pager of