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"°U`" .o Body Art Inspect* Report C /G1 V I MACHINE SAFETY AND SANITATION (cont.) Date: ❑ 1 San Joaquin County Environmental Health Department El22' El 1868 E. Hazelton Ave., Stockton, CA 95205 Program Record: ❑ 2 (209) 468-3420 Program °c;F_oRa` www.siogy-org/ehd Element: �{ ► Zd Facility Name Address City Zip Code Port City Ink 1415 rosemarie In # b Stockton 95207 Name of Permit/Registration Holder Permit Exp. Date Time In Time Out Inspection Type Marissa Correa-Amaya 6/30/15 2:05 3:10 Final/Routine The above facility is inspected for compliance with Division 104, Part 15, Chapter 7 of California Health and Safety Code (HSC). V = Violation C = Corrected On Site V I CLEANING AND STERILIZATION C I V I MACHINE SAFETY AND SANITATION (cont.) C ❑ 1 Autoclave: approved and effective - passed integrator El22' El Parts replaced between clients - grommets, elastic bands, etc. Eltest ❑ 2 Items washed, disinfected, packaged, labeled, and sterilized E]PREVENTING CROSS -CONTAMINATION ❑ 3. Autoclave loaded correctly/packages allowed to dry ❑ ❑ 23. Workstation/procedure area decontaminated ❑ ❑ 4. Integrators used/monthly spore test/log maintained ❑ ❑ 24. Appropriate chemical disinfectant used ❑ ❑ 5 Decontamination/sanitation area separated and supplied appropriately E]Chemical used: Madacide ❑ 6 Invoices and log kept for disposable, pre -sterilized equipment El El25. Disinfectant used appropriately/sufficient contact time ❑ ❑ 7 Sharps containers labeled, used, and disposed of appropriately ElWet contact time provided: 3 mins ❑ 8 Jewelry, tattoo and piercing equipment - clean and sterilized El El26. Barriers used ❑ HEALTH AND HYGIENE ❑ 27 Products applied to skin are single use/dispensed aseptically ElPRACTITIONER ❑ 9. No eating, drinking or smoking - clean clothes ❑ ❑ 28. Storage of inks, pigments, needles, tubes, etc. ❑ ❑ 10. Hands washed effectively and timely ❑ ❑ 29. Jewelry, Inks, Needles etc approved and used correctly ❑ ❑ 11. Handwashing facilities properly supplied and accessible, warm water El ❑ 30. Cross -contamination avoided during all phases of procedure ❑ ❑ 12. Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES ❑ 13. Bloodborne Pathogen training ❑ ❑ 31. Areas separated/no living or sleeping quarters ❑ Source: Above Training ❑ 32. Floors and walls clean and in good repair, adequate light ❑ ❑ 14. Appropriate personal protective equipment available and El [1 33. Workstation, surfaces, including chairs, armrests, etc. in good repair Elused CUSTOMERS/CLIENTS ❑ 34. Permit/registration posted ❑ ❑ 15 Branding is completed with no other customers in rocedure area ❑ El 35. Operation and employee training records present El ❑ 16. Customers eighteen (18) years of age or older ❑ COMPLIANCE AND ENFORCEMENT ❑ 17. Skin adequately prepared for procedure ❑ ❑ 36. Plan(s) submitted for review ❑ ❑ 18 Client records approved and available - Consent form and questionnaire ❑ ❑ 37. Permits obtained and available ❑ ❑ 19. Appropriate aftercare instructions given to client ❑ ❑ 38. Impoundment ❑ MACHINE SAFETY AND SANITATION ❑ 39. Hearing scheduled ❑ ❑ 20. Safe machine design ❑ ❑ 40. Closure ❑ ❑ 21. Machines cleaned and disinfected between clients ❑ ❑ 41. ❑ t� Received b (Print): CI Received by (Signature): Phone: 2-09 r Wl-UC Specialist (Print): Specialist (Signature): ` Phone: O+y(g- 2 Reinspeclon on/about: A reinspection fee of $125 per hour may charged. Page 1 of 2 EH -04/2014