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c <br /> Body Art Inspecle Report Date: <br /> �. , San Joaquin County Environmental Health Department Program 1 <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: S Cbb/! � <br /> (209)468-3420 Program <br /> www.siogv.org/ehd <br /> Element: <br /> Facility Name Address City Zip Code <br /> Kym With a Y Organic Spa and Waxing Studio 307 b lincoln center Stockton 95207 <br /> Name of Permit/Registration Holder Permit Exp.Date Time In Time Out Inspection Type <br /> Kym Thompson Consultation <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 ❑ ❑ 7Parts replaced between clients-grommets,elastic bands, E]test etc. <br /> ❑ <br /> Items washed,disinfected,packaged,labeled,and 2. sterilized PREVENTING 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 /> Decontamination/sanitation area separated and supplied ❑ <br /> ❑ 5' appropriately ❑ Chemical used: <br /> Invoices and log kept for disposable,pre-sterilized <br /> ® 6. equipment ❑ El25. Disinfectant used appropriately/sufficient contact time <br /> E]Sharps containers labeled, used,and disposed of <br /> ® 7' Elappropriately <br /> [Wet contact time provided: <br /> Jewelry,tattoo and piercing equipment-clean and <br /> ❑ 8' El El 26. Barriers used <br /> sterilized <br /> Products applied to skin are single use/dispensed <br /> El <br /> PRACTITIONER HEALTH AND HYGIENE ® 27' 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 /> ® <br /> Handwashing facilities properly supplied and accessible, Cross-contamination avoided during all phases of 11. warm water El ❑ 30' procedure El <br /> ® 12. Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES <br /> ❑ 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 ❑ <br /> used good repair <br /> CUSTOMERS/CLIENTS ® 34. Permit/registration posted ❑ <br /> ❑ <br /> Branding is completed with no other customers in 15. ❑ ® 35. Operation and employee training records present Elrocedure 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 /> Client records approved and available-Consent form <br /> ® 18. and questionnaire <br /> ❑ ❑ 37. Permits obtained and available E] <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): Kym Thompson Received b Si nature: Phone: 209 952-2299 <br /> Specialist(Print): Benjamin Escotto,Sr REHS Specialist(Signature): k Phone: 209 468-3178 <br /> Reinspecton onlabout: A reinspection fee of$130 per hour may be charged. Page 1 of 3 <br /> EH-03/2015 <br />