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p• � Body Art InspeA Report if Date: �/?✓��� <br /> San Joaquin County Environmental Health Department Program / qQ3 <br /> a 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: ,Qd 76 / <br /> (209)468-3420 Program (� <br /> L,FbR www.siogv.org/ehd Element: '1 1 03 <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 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 STER1EFZa4ION . •< °G` Y MACffl�[E SAFETY ANE}SANIF1TtflE,`Ecs <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' Elsterilized PREVEE4G GlSSQIA ON, '. . ' _- <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 nt log kept for disposable,pre-sterilized <br /> ❑ El 6. 25. Disinfectant used appropriately/sufficient contact time <br /> a ui me <br /> Sharps containers labeled, used,and disposed of ❑ <br /> El 7. a ro riatel El Wet contact time provided: 4 mins,5 mins <br /> Jewelry,tattoo and piercing equipment-clean and <br /> ❑ 8. ❑ ❑ 26. Barriers used Elsterilized <br /> Products applied to skin are single use/dispensed <br /> PRACTITIONER HEALTH AND HYGIENE El 27' ase ticall ❑ <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. 30 <br /> warm water ❑ ❑ ' procedure ❑ <br /> ❑ 12. Hepatitis B vaccination ❑ <br /> BEST E ktSINESS;PRACTICES <br /> ❑ 13. Bloodborne Pathogen training ❑ ❑ 31. Areas separated/no living or sleeping quarters ❑ <br /> Source: Cathie Montie ❑ 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 /> CEFSTdMERS/CLIEIFS ❑ 34. Permit/registration posted ❑ <br /> Branding is completed with no other customers in <br /> El 15. rocedure area El El 35. Operation and employee training records present El <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 /> El [137. Permits obtained and available Eland <br /> ❑ 19. Appropriate aftercare instructions given to client ❑ ❑ 38. Impoundment ❑ <br /> MACHINESAFETYarNDSANtTATION ❑ 39. Hearing scheduled ❑ <br /> ❑ 20. Safe machine design ❑ ❑ 40. Closure ❑ <br /> ❑ 21. Machines cleaned and disinfected between clients ❑ ❑ 41. ❑ <br /> Received b (Print): Stacey Moffat Received by(Signature): 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 />