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00 ,o�qu o Body Art Inspection Report Date(MM/DD/YY) r y County of San Joaquin County,Environmental Health Department Permit Number P7U06Z_-�lee, < 1868 E.Hazelton Ave.,Stockton CA 95205 (209)468-3420 www.siciov.org/ehd �r Permit Type Facility Name Address City Zip Code CT Oc v k e: Lti�� OIL wm t h- ��- .S�1 ) 0 _i?/7 Permit/Registration Holder Name Permit Exp.Date Total Time Inspection Typel 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 N/O=Not Observed NIA=Not Applicable COS=Corrected On Site TATTOO AND PERMANENT COSMETICS MACHINE' CLEANING AND STERILIZATION our Cos SAFETY AND SANITATION our_cos In NIO 1. Autoclave is approved and effective-passed In N/0 18. Safe machine design 11 NIA integrator test /A In N/O 2. Process of cleaning,labeling,packaging and NA N10 19. Machines cleaned and disinfected between 0 0 sterliziin items correct) clients In N/0 3. Autoclave loaded correctlylpackages allowed to [3 n N10 20. Parts replaced between clients grommets, ! d N/A elastic bands,etc. 0 EI n N10 4. Integrators used/monthly spore testllogPREVENTING CROSS-CONTAMINATION /A maintained n N/O 5. Decontamination/sanitation area separate and n N/0 21. Workstation/procedure area decontaminated 0 13 lA supplied IA In N/O 6. Invoices and log kept for disposable,pre- n N/O 22. Chemical disinfectant used El 0/A sterilized equipment,backu supplies available* IA Chemical used: n /O 7. Sharps containers supplied,labeled,used and I N/O 23. Disinfectant used sufficient contact time Wet IA disposed of correctly* N/A contact timeprovided: - In 8. Jewelry,tattoo and piercing equipment-storage ❑ 0 NIO 24. Barriers available and used as part of U 17 NIA and use N/A procedure N/O 25. Products applied to skin are single 11 0 PRACTITIONER'HEALTH AND HYGICNE NIA useldis ensed aseptically In N/O 9. No eating,drinking or smoking-clean clothesn. N/0 26. Storage of inks,pigments,needles,tubes,etc., El 11 N/A In t7 11AO 10. Hands washed effectively and timely 17 ❑ In N/0 27. Jewelry,Inks,Needles etc approved and used I In N/0 11. Handwashing facilities properly supplied and In 28. Cross contamination avoided during all phases 0 A accessible,warm potable water* of procedure (YN/0 12. Personal protective equipment available and 17 ❑ BEST BIfS(NESS`PRACTICES NIA I used,eyewash station available CUSTOMERSICLIEN75` In 0 29. Areas separated/no living or sleeping El 11 lAquarters/no animals In ULO 13. Branding is completed with no other customers in ❑ 0 10 30. Floors and walls clean and in good repair, ❑ 11 MA procedure area adequate li ht 10 14. Customers eighteen(18)years of age or older n 10 31. Workstation,surfaces,including chairs,,etc.in El 0NIA /A good repair;trash removed fre uentl * // IO 15. Skin prepared for procedure. 0 cc] n AO 32. Permit/registration and required signs posted* ❑ 11 uN A 'n N/0 16. Client records available-Consent form& 0 11N/0 33. IPCP and employee training records and 0 0 NIA questionnaire v A He atitiis B vaccination status present n WO 17. Aftercare instructions given to client I7 El In N/0 34 Restrooms available,stocked* 0 0 /A NIA Received b (Print): Y Received b (Signature): Phone: Specialist(Print): Specialist(Signature): Phone: F1This 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) Page-of-