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SAN JOAO U IN Environmental Health Department <br /> Body Art Inspection Report <br /> Facility Name: Facility Address: Date: <br /> OLD VINE TATTOO(PALMER, JOSH) 521 W KETTLEMAN LN, LODI July 07, 2021 <br /> Preventing Cross Contamination <br /> 25 HSC 119309(b) Disinfectant used appropriately/sufficient contact time V :1 COS <br /> 26 HSC 119311(h) Barriers used E V -1 COS <br /> 27 HSC 119311(a) Products applied to skin are single use/dispensed aseptically C V -1 COS <br /> 28 HSC 119315 Storage of inks, pigments,needles,tubes,etc. ❑V :1 COS <br /> 29 HSC 119310, 1193f1 Jewelry, Inks, Needles etc approved and used correctly ❑V ❑COS <br /> 30 HSC 119309 Cross-contamination avoided during all phases of procedure ❑V n CCS <br /> Best Business Practices <br /> 31 HSC 119314 Areas separatedlno living of sleeping quarters V CCS <br /> 32 HSC 119314, 119317 Floors and walls clean and in good repair,adequate light ■V ❑CCS <br /> 33 HSC 119314 Workstation,surfaces,including chairs,armrests,etc.in good repair ■V ❑COS <br /> 34 HSC 119306, 119312 Perm itiregistrati on pasted ❑V ❑COS <br /> 35 HSC 119313 Operation and employee training records present ■V I CC'S <br /> Compliance and Enforcement <br /> 36 HSC 119312 Plan(s)submitted for review ❑V ❑COS <br /> 37 HSC 119312, 119306 Permits obtained and available ■V ❑COS <br /> 38 HSC 119319 Impoundment ❑V ❑COS <br /> 39 HSC 119320 Hearing scheduled ❑V ❑COS <br /> 40 HSC 119320 Closure ❑V ❑COS <br /> Other Violations <br /> 41 See below Other violations ❑V ❑COS <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Item# Remarks <br /> 6 HSC 119315(f) Invoices and log kept for disposable, pre-sterilized equipment. <br /> A facility that us=_s single use instruments shall maintain record of purchase, log of procedures, names of <br /> practiticner and client, date of procedure, instruments used, and written evidence from the manufacture that the <br /> in3truments have undergone sterilization. The record of purchase, evidence of sterilization, type and number of <br /> instruments used shall be maintained for a minimum of 90 days after use. HSC 119315(f)-Invoices and <br /> st3rilization certi-icate was not available for the following needles: BLACK CLAW LOT#200901, TATSOUL LOT <br /> #00501, and TF.TSOUL LOT#201201. Provide EHD with invoices and sterilization certificates for the above <br /> mentioned instruments. - ►i'f Y)(- <br /> 7 <br /> i(7 HSC 119314(e) Sharps containers labeled, used, and disposed of approllriately. <br /> The sharps waste container shall be within arm's reach and labeled with the word "sharps waste" or with the <br /> biohazard symbol and the word"Biohazard". Sharp waste containers shall be disposed by a licensed waste haular <br /> or approved mai back system. Documentation of proper disposal shall be maintained for 3 years. HSC 119314(e) <br /> -Provide proof cf sharps disposal record to EHD. <br /> FA0026192 PRO546258 SC001 07n7/2021 <br /> EHD Rev.6/15/2021 Page 2 of 4 EodyArt 01R <br /> 1868 E. Hazelton A�.enue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br />