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Body Art Inspeco Report 46 Date: <br /> o.-,•.:,..,,� x-13- l t <br /> San Joaquin County Environmental Health Department Program <br /> 1868 E.Hazelton Ave,,Stockton,CA 95205 Record: <br /> (209)468-3420 <br /> �•.. •p Program <br /> www.siogy.org/ehd L <br /> Element: «� <br /> Facility Name Address City Zip Code <br /> Black Rose Tattoo Parlor 237 a miner ave Stockton 95206 <br /> Name of Permit/Registration Holder Permit Exp.Date Time In Time Out Inspection Type <br /> Hugo Villa 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 /> 0 1 Autoclave:approved and effective-passed integrator Parts replaced between clients-grommets,elastic bands, Eltest ❑ ❑ 22. etc. <br /> 2 Items washed,disinfected,packaged,labeled,and <br /> sterilized ElPREVENTING 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 /> 5 Decontamination/sanitation area separated and supplied ❑ <br /> ElChemical used: <br /> appropriately <br /> Ei 6. <br /> ro riatel <br /> Invoices and log kept for disposable,pre-sterilized <br /> ❑ 6 ui ment El El 25. Disinfectant used appropriately/sufficient contact time <br /> 7 Sharps containers labeled,used,and disposed of ❑ <br /> ElWet contact time provided: <br /> appropriately <br /> 8 Jewelry,tattoo and piercing equipment-clean and <br /> El El 26. Barriers used E]sterilized <br /> ❑ 27 Products applied to skin are single use/dispensed ❑ <br /> PRACTITIONER HEALTH AND HYGIENE aseptically <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 /> 11. Handwashing facilities properly supplied and accessible, ❑ ❑ 30 Cross-contamination avoided during all phases of ❑ <br /> warm water procedure <br /> ❑ 12. Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES <br /> 621 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 /> ❑ 14. Appropriate personal protective equipment available and ❑ ❑ 33 Workstation,surfaces, including chairs,armrests,etc. in Elusedgood repair <br /> CUSTOMERS/CLIENTS 34. Permit/registration posted ❑ <br /> Branding is completed with no other customers in <br /> El 15. rocedure area El35. Operation and employee training records present El <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 /> 18 Client records approved and available-Consent form ❑ ❑ 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. l� ❑ <br /> Received b (Print): Hugo Villa Received b Si natur • Phone:`` 0 - r <br /> Specialist(Print): Afonso Arambula Specialist(Signature): Phone: 209 468-9673 <br /> nrTefrT <br /> Reinspecion on/about: A reinspection fee of$125 per hour may klhaijle . Page 1 of 3 <br /> EH-04/2014 <br />