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Body Art Inspect*ReportDate: �]� ���1 <br /> San Joaquin County Environmental Health Department Program 1039 <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: <br /> .. P -3420(209)468 <br /> Program <br /> www.siogv.org/ehd (' <br /> Element: -t1Zb <br /> Facility Name Address City Zip Code <br /> Renaissance Salon 111 n.church st. Lodi 95240 <br /> Name of Permit/Registration Holder Permit Exp. Date Time In Time Out Inspection Type <br /> Kirsten Patterson 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 /> El Autoclave:approved and effective-passed integrator El ❑ 22.7Parts replaced between clients-grommets,elastic bands, El <br /> 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 ❑ ❑ 24. Appropriate chemical disinfectant used <br /> Decontamination/sanitation area separated and supplied ❑ <br /> ❑ 5' appropriately ❑ Chemical used: Clorox Wipes,Tammy Taylor Disinfectant <br /> Invoices and log kept for disposable,pre-sterilized <br /> ❑ 6' r_1 El 25. Disinfectant used appropriately/sufficient contact time <br /> equipment <br /> 1:1Sharps containers labeled,used,and disposed of <br /> ❑ 7' ❑ Wet contact time provided: 4 mins,5 mins <br /> appropriately <br /> ❑ 8 Jewelry,tattoo and piercing equipment-clean and <br /> 11 El 26. Barriers used F1sterilized <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 /> ❑ 11. ,Harm water ❑ ❑ 30. procedure ❑ <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 /> Appropriate personal protective equipment available and Workstation,surfaces,including chairs,armrests,etc.in <br /> El 14. used El ❑ 33' good repair 13 <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 E]rocedure 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 /> El 18. questionnaire <br /> ❑ ❑ 37. Permits obtained and available Eland <br /> ❑ 19. 1 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): Kristen Patterson Received b Si natur - Phone:209 329-7846 <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 />