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a c Re ortBod Art Inspe l <br /> Date: <br /> < <br /> a: M Z <br /> San Joaquin County Environmental Health Department <br /> Program <br /> pi 6 <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: 5 3�66 y 2 <br /> c .P• (209)468-3420 Program <br /> www.siogv.orq/ehd Element: 12 <br /> Facility Name Address City Zip Code <br /> Quarter Horse Tattoo 916 yosemite st Stockton 95203 <br /> Name of Permit/Registration Holder Permit Exp. Date Time In Time Out Inspection Type <br /> Geoff H. Rogers 6/30/16 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.T' arts replaced between clients-grommets,elastic bands, ❑ <br /> testetc. <br /> Items washed,disinfected,packaged,labeled,and <br /> F-1 2' sterilized E] PREVENTING CROSS-CONTAMINATION <br /> ❑ 3. Autoclave loaded correctly/packages allowed to dry ❑ ❑ 23. Workstation/procedure area decontaminated ❑ <br /> ❑ 4. Integrators used/monthly spore testllog maintained [:1 ❑ 24. Appropriate chemical disinfectant used <br /> Decontamination/sanitation area separated and supplied El® 5. ElChemical used: Cavicide <br /> appropriately <br /> * 6. <br /> ro riatel <br /> Invoices and log kept for disposable,pre-sterilized <br /> ® 6• F1 El 25. Disinfectant used appropriately/sufficient contact time <br /> equipment <br /> ElSharps containers labeled, used,and disposed of <br /> ® 7' ap ro riatel F1 et contact time provided: 10 mins <br /> - -1 F <br /> Jewelry,tattoo and piercing equipment-clean and <br /> F-1 8' El El 26. Barriers used <br /> sterilized <br /> Products applied to skin are single use/dispensed <br /> PRACTITIONER HEALTH AND HYGIENE F-1 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 <br /> ❑ 11. warm water F-1 ❑ 30. procedure <br /> E] <br /> ❑ 12. Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES <br /> ® 13. Bloodborne Pathogen trainingElEl31. Areas separated/no living or sleeping quarters ❑ <br /> Source: Cathie Montie ® 32. Floors and walls clean and in good repair,adequate light ❑ <br /> Appropriate personal protective equipment available and ElWorkstation,surfaces,including chairs,armrests,etc.in E]❑ 14. used ® 33. ood repair <br /> CUSTOMERS/CLIENTS ❑ 34. Permit/registration posted ❑ <br /> Branding is completed with no other customers in <br /> El 15. ❑ ® 35. Operation and employee training records present <br /> procedure 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. ❑ ❑ 37. Permits obtained and available <br /> and questionnaire ❑ <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 ❑ ❑ 41. ❑ <br /> Received b (Print): Geoff Rogers Received b (Signature): Phone: 209)227-8374 <br /> Specialist(Print): Har rit Mattu,Sr REHS Specialist(Signature): Phone: 209 468-3284 <br /> Reinspecion on/about: A reinspection fee of$130 per hour may be charged. Page 1 of 2 <br /> EH-03/2015 <br />