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Body Art Inspects Report Date: I <br /> w` San Joaquin County Environmental Health Department Program (; <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: t S <br /> (209)468-3420 <br /> Program <br /> •\`c4tlFoaa�,,,, www.sioay.or_gJehdLl ( 2( <br /> Element: <br /> Facility Name Address City Zip Code <br /> Black Kobra Tattoo 742 e.weber ave. Stockton 95202 <br /> Name of Permit/Registration Holder Permit Exp.Date Time In Time Out Inspection Type <br /> Jeremy Acevedo 6/30/19 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 Parts replaced between clients-grommets,elastic bands, ❑ <br /> test etc. <br /> Items washed,disinfected,packaged,labeled,and <br /> ® 2 sterilized El 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 ❑ [01 24. Appropriate chemical disinfectant used <br /> Decontamination/sanitation area separated and supplied Chemical used: E]❑ 5' <br /> appropriately <br /> ❑ <br /> Invoices and lag kept for disposable,pre-sterilized <br /> ❑ 6. ❑ [125. Disinfectant used appropriately/sufficient contact time <br /> equipment <br /> Sharps containers labeled,used,and disposed of ❑ <br /> ❑ 7. a ro riatel ElWet contact time provided: <br /> ❑ <br /> Jewelry,tattoo and piercing equipment-clean and 8" ❑ El 26. Barriers used <br /> sterilized <br /> Products applied to skin are single use/dispensed <br /> PRACTITIONER HEALTH AND HYGIENE El 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 /> El 11. warm water El F1 30' procedure ❑ <br /> ❑ 12. Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES <br /> ❑ 13. Bloodborne Pathogen trainingEl ❑ 31. Areas separated/no living or sleeping quarters El <br /> Source: ® 32. Floors and walls clean and in good repair,adequate light ❑ <br /> Appropriate personal protective equipment available and Workstation,surfaces,including chairs,armrests,etc.in <br /> El 14. used El ❑ 33. good repair <br /> El <br /> CUSTOMERS/CLIENTS ❑ 34. Permit/registration posted ❑ <br /> Branding is completed with no other customers in <br /> El 15. rocedure area E] [135. Operation and employee training records present ❑ <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 El <br /> Client records approved and available-Consent form <br /> ❑ 18. and questionnaire <br /> ❑ ® 37. Permits obtained and available El® 19. Appropriate aftercare instructions given to client El ❑ 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):VCReceived b (Signature): � �'� �� Z2twne: ZO q 7 q z <br /> Specialist(Print): <br /> Specialist(Signature): Phone: xq yT�k to <br /> Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Page 1 of 2 <br /> EH-11/17 <br />