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J6ma-roc*&*& mail , tpY►1 <br /> 4L, <br /> Body Art Inspection ReportDate: 9IS I19San Joaquin County Environmental Health Department Pro ram <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: la R5 A/eZ G L,F <br /> (209)468-3420 Program <br /> a`P ._siogv.oro/ehd Element: �4 162 <br /> Facility Name Address City Zip Code <br /> Lodi Micro Clinic 755 south fairmont ave suite c Lodi 95240 <br /> Name of Perm it/Registration Holder Permit Exp.Date Time In Time Out Inspection Type <br /> Blanca Rodriquez 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 ❑ ❑ 22T Parts replaced between clients-grommets,elastic bands, ❑ <br /> test etc. <br /> Items washed,disinfected,packaged,labeled,and <br /> F-1 2. sterilized E] PREVENTING CROSS-CONTAMINATION <br /> ❑ 3. Autoclave loaded correctly/packages allowed to dry ❑ ❑ 23. Workstation/procedure area decontaminated El <br /> ❑ 4. Integrators used/monthly spore test/log maintained [I El 24. Appropriate chemical disinfectant used <br /> Decontamination/sanitation area separated and supplied El <br /> ❑ 5. appropriately El Chemical used: <br /> Invoices and log kept for disposable,pre-sterilized <br /> ® 6. rEEI <br /> El 25. Disinfectant used appropriately/sufficient contact time <br /> equipment ElSharps containers labeled,used,and disposed of <br /> ® 7. appropriately Wet contact time provided: <br /> Jewelry,tattoo and piercing equipment-clean andEl8. sterilized ❑ 26. Barriers used ❑ <br /> Products applied to skin are single use/dispensed <br /> PRACTITIONER HEALTH AND HYGIENE ❑ 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 [_1 ❑ 29. Jewelry,Inks,Needles etc approved and used correctly ❑ <br /> Handwashing facilities properly supplied and accessible, E] 30. Cross-contamination avoided during all phases of E]❑ 11. warm water ❑ procedure <br /> ❑ 12. Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES <br /> ® 13. Bloodborne Pathogen training ❑ 31. Areas separated/no living or sleeping quarters El <br /> El 31. <br /> 32. Floors and walls clean and in good repair,adequate light E]Appropriate personal protective equipment available and Workstation,surfaces,including chairs,armrests,etc.in <br /> ❑ 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. procedure area ❑ ® 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 /> ® 18. El El 37. 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): Blanca Rodriguez Received by(Signature): Phone:209-327-6342 <br /> Specialist(Print): Sandip Singh Specialist Si nature : il Phone: 209-468-3526 <br /> Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Page 1 of 2 <br /> EH-11/17 <br />