|
•
<br />I 1
<br />Date (WWDDNY) _1
<br />Permit Number
<br />Permit Type -01
<br />Facility Name Address city Zip Code CT
<br />�a�Vic, -HmL2 6S9 Af- d2art, P Si- -
<br />PermWRegishaftri Holder Name Permit Exp. Date TotalTimeInspec§Dn Type
<br />"VOW
<br />V
<br />Risk fac
<br />Ln
<br />.1ors of cross -contamination.
<br />Interventions an t --s from one person to another.
<br />In = In Compliance
<br />COS = Corrected On Site
<br />HTCOSMETIGS MACHINE
<br />CLEANING AND STEI
<br />our: cos
<br />In 1. Autoclave is W
<br />integrator test 0 0
<br />In 0 Z Process of clearill
<br />n Ch j between
<br />simMing items co. t 0 0
<br />n 3. Autodave loaded c
<br />dry i - grommets, 171 13
<br />Cb
<br />In WO 4. Integrators usedimi: 00
<br />AMINATION
<br />AA maintained
<br />5. Decontamination/s3Jh6
<br />area decontaminated
<br />- Z1441 1 E3 0
<br />71-h)NIO 6. Invoices and log ked
<br />c used
<br />--/N/A sterilized equipment, El 0
<br />Vn KJO 7. Sharps Containers SL
<br />gullicient contact time Wet
<br />NIA C&US 0 L01
<br />sided
<br />,UnNNIO 8. Jewelry, tattoo and
<br />-ale and used as part of
<br />NIA and use E3 0
<br />R, pplied to skin are single
<br />PRACTITIONER HEALTH A13 0
<br />used aseptically
<br />n,"o 9. No eating, drinking Or,
<br />of inks, pigments, needles, tubes, etc.,
<br />N
<br />E3 13
<br />InXq) 10. Hands washed effectiv
<br />hfx�r ry, Inks, Needles etc approved and used fl
<br />0
<br />hvo 11. Handwashing
<br />facilities,
<br />sass contamination avoided during all phases ❑
<br />13
<br />VIA accessibl% warm Dotat
<br />of procedure
<br />(C in' N/O 12. Personal proftrfive eqi 'BUSINES9 PRACTICES'
<br />\--:'NIA used, eyewash station F
<br />CIPSTOMERSICUENTSig. Areas separated1no living orsleeping
<br />0 0
<br />quarters1no animals
<br />InAO 13. Branding is coinpie-
<br />30. Floors and walls dean and in good repair,
<br />IIIA, procedure area0 E31
<br />adeWate light
<br />n 0 14. Customers eic A 31. Workstation, surfaces, including chairs,, etc. in
<br />hteen
<br />0
<br />NIA
<br />I� NIO 15. Skin prepared for proce good repair. bash removed lEre(wily *
<br />WO 32. Pearlil/registration and required signs posted
<br />NIA 0 0 i
<br />4-
<br />$A
<br />In 0 16. Client records available - Consent form & U j NIO 33. IPCP and employee training records and 0
<br />NIcluestionnaire AA I Hepaft B vaccination status preserit 0
<br />WO 17. Aftercare instructions given to client
<br />�AO 1 34 Reftorrm available, stocked 0 0
<br />A NUA
<br />Received by (Print): Received by, (Signature)- Phone:
<br />Specialist (Print): Specialist (Signature): Phone:
<br />This report is an Official Notice of Violation. Corrections must be completed in the time specified.
<br />A reinspectionI fee may be charged if violations noted on this report are not corrected by the reinspection date. Reinspection Date (on or aboU
<br />pmn. 1 ref "?
<br />Body Art Inspection Report
<br />County of San Joaquin Comty, Environmental Health Department
<br />IBM E Hazelton Ave, Stockton CA 95205
<br />(209)4683420 wwsixpy�arafehd
<br />I 1
<br />Date (WWDDNY) _1
<br />Permit Number
<br />Permit Type -01
<br />Facility Name Address city Zip Code CT
<br />�a�Vic, -HmL2 6S9 Af- d2art, P Si- -
<br />PermWRegishaftri Holder Name Permit Exp. Date TotalTimeInspec§Dn Type
<br />"VOW
<br />V
<br />Risk fac
<br />Ln
<br />.1ors of cross -contamination.
<br />Interventions an t --s from one person to another.
<br />In = In Compliance
<br />COS = Corrected On Site
<br />HTCOSMETIGS MACHINE
<br />CLEANING AND STEI
<br />our: cos
<br />In 1. Autoclave is W
<br />integrator test 0 0
<br />In 0 Z Process of clearill
<br />n Ch j between
<br />simMing items co. t 0 0
<br />n 3. Autodave loaded c
<br />dry i - grommets, 171 13
<br />Cb
<br />In WO 4. Integrators usedimi: 00
<br />AMINATION
<br />AA maintained
<br />5. Decontamination/s3Jh6
<br />area decontaminated
<br />- Z1441 1 E3 0
<br />71-h)NIO 6. Invoices and log ked
<br />c used
<br />--/N/A sterilized equipment, El 0
<br />Vn KJO 7. Sharps Containers SL
<br />gullicient contact time Wet
<br />NIA C&US 0 L01
<br />sided
<br />,UnNNIO 8. Jewelry, tattoo and
<br />-ale and used as part of
<br />NIA and use E3 0
<br />R, pplied to skin are single
<br />PRACTITIONER HEALTH A13 0
<br />used aseptically
<br />n,"o 9. No eating, drinking Or,
<br />of inks, pigments, needles, tubes, etc.,
<br />N
<br />E3 13
<br />InXq) 10. Hands washed effectiv
<br />hfx�r ry, Inks, Needles etc approved and used fl
<br />0
<br />hvo 11. Handwashing
<br />facilities,
<br />sass contamination avoided during all phases ❑
<br />13
<br />VIA accessibl% warm Dotat
<br />of procedure
<br />(C in' N/O 12. Personal proftrfive eqi 'BUSINES9 PRACTICES'
<br />\--:'NIA used, eyewash station F
<br />CIPSTOMERSICUENTSig. Areas separated1no living orsleeping
<br />0 0
<br />quarters1no animals
<br />InAO 13. Branding is coinpie-
<br />30. Floors and walls dean and in good repair,
<br />IIIA, procedure area0 E31
<br />adeWate light
<br />n 0 14. Customers eic A 31. Workstation, surfaces, including chairs,, etc. in
<br />hteen
<br />0
<br />NIA
<br />I� NIO 15. Skin prepared for proce good repair. bash removed lEre(wily *
<br />WO 32. Pearlil/registration and required signs posted
<br />NIA 0 0 i
<br />4-
<br />$A
<br />In 0 16. Client records available - Consent form & U j NIO 33. IPCP and employee training records and 0
<br />NIcluestionnaire AA I Hepaft B vaccination status preserit 0
<br />WO 17. Aftercare instructions given to client
<br />�AO 1 34 Reftorrm available, stocked 0 0
<br />A NUA
<br />Received by (Print): Received by, (Signature)- Phone:
<br />Specialist (Print): Specialist (Signature): Phone:
<br />This report is an Official Notice of Violation. Corrections must be completed in the time specified.
<br />A reinspectionI fee may be charged if violations noted on this report are not corrected by the reinspection date. Reinspection Date (on or aboU
<br />pmn. 1 ref "?
<br />
|