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Body Art Inspect Report so Date: 7 /1-3 /26 `; <br /> San Joaquin County Environmental Health Department Program 4 0 � <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: <br /> P (209)468-3420� Program WWW.siogv.org/ehd 9 Z� <br /> F_.= Element: v <br /> Facility Name Address City Zip Code <br /> Lumiere Spa 15 w.oak st. Lodi 95240 <br /> Name of Permit/Registration Holder Permit Exp.Date Time In Time Out Inspection Type <br /> Georgina Anaya Final/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 E] ❑ 7Parts replaced between clients-grommets,elastic bands, Eltest 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 /> [1 4. Integrators used/monthly spore test/log maintained ❑ ❑ 24. Appropriate chemical disinfectant used <br /> Decontamination/sanitation area separated and supplied Elappropriately <br /> El 5' ElChemical used: Cavi-wipes <br /> ® <br /> Invoices and log kept for disposable,pre-sterilized 6• ❑ ❑ 25. Disinfectant used appropriately/sufficient contact time <br /> equipment <br /> 1-1Sharps containers labeled,used,and disposed of <br /> E] 7' a ro riatel El Wet contact time provided: 2 mins <br /> ❑ <br /> Jewelry,tattoo and piercing equipment-clean and 8' El El 26. Barriers used 13sterilized <br /> Products applied to skin are single use/dispensed <br /> PRACTMONER HEALTH AND HYGIENE El 27' aseptically1:1 <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,® 30' Cross-contamination avoided during all phases of 11' warm water ❑ ❑ procedure E] <br /> ❑ 12. Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES <br /> ❑ 13. Bloodborne Pathogen training ❑ 31. Areas separated/no living or sleeping quarters ❑ <br /> Source: Biologix ❑ 32. Floors and walls clean and in good repair,adequate light ❑ <br /> ❑ <br /> Appropriate personal protective equipment available and Workstation,surfaces,including chairs,armrests,etc.in 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 /> ❑ 15. rocedure area El El 35. Operation and employee training records present El <br /> ❑ 16. Customers eighteen(18)years of age or olderrEMI <br /> 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. El37. 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): Georgina Ana a Received by(Signature): Phone: 209 625-8970 <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 />