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SAN J O AQ U I N Environmental Health Department <br /> - , JN FIT <br /> Body Art Inspection Report <br /> Faci ty Name: Date: <br /> OLE VINE TATTOC(PALMER, JOSH) July 22, 2021 <br /> Faci ity Address: Facility Phone: Program Record: <br /> 521 W KETTLEN1AN LN, LODI, CA 95242 (209) 395-9553 PR0546258 <br /> Perr it Holder: Permit Expiration Date: <br /> PALMER JOSH June 30, 2022 <br /> Inspection Type: Program: <br /> RO JTINE SUPPLEMENTAL ACTIVITY-Operating Permit 4120-BODY ART FACILITY-SINGLE USE <br /> The Ebcve facility is inspected for compliance with Division 104,Part 15,Chapter 7 of the California Health and Safety Code(HSC). <br /> V=Violation COS=Corrected on site <br /> Cleaning and Sterilization <br /> 1 HSC 119315(t) Autoclave:approved and effective-passed integrator test V COS <br /> 2 HSC 119309. Items washed,disinfected, packaged,labeled,and sterilized ❑V ❑COS <br /> 119315(a) <br /> 3 HSC 119315;t) Autoclave loaded correctly/packages allowed to dry ❑V ❑COS <br /> 4 HSC 119315;t.) Integrators used/monthly spore test/log maintained ❑V ❑COS <br /> 5 HSC 119314(c) Decontamination/sanitation area separated and supplied appropriately ❑V ❑COS <br /> E HSC 119313(fi Invoices and log kept for disposable,pre-sterilized equipment ■V ❑COS <br /> 7 HSC 119314(e) Sharps containers labeled,used,and disposed of appropriately ■V ❑COS <br /> E HSC 11931) Jewelry,tattoo and piercing equipment-clean and sterilized ❑V ❑COS <br /> Practitioner Health and Hygiene <br /> 9 HSC 119309 No eating,drinking or smoking-clean clothes V COS <br /> 13 HSC 11930Na) Hands washed effectively and timely ❑V ❑COS <br /> 11 HSC 119314(b) Handwashing facilities properly supplied and accessible,warm water ❑V ❑COS <br /> 12 HSC 119306(c) Hepatitis B vaccination ❑V ❑COS <br /> 13 HSC 119307 Bloodborne Pathogen training ■V ❑COS <br /> 14 HSC 119308(,; Appropriate personal protective equipment available and used ❑V ❑COS <br /> Customers/Clients <br /> 15 HSC 1193C9(D Branding is completed with no other customers in procedure area ❑V ❑COS <br /> 16 HSC 119302 Customers eighteen(18)years of age or older ❑V ❑COS <br /> 17 HSC 1193C8(•3i Skin adequately prepared for procedure ❑V ❑COS <br /> 18 HSC 1193C3 Client records approved and available-Consent form and questionnaire ■V ❑COS <br /> 19 HSC 1193CS(,) Appropriate aftercare instructions given to client ❑V c COS <br /> Machine Safety and Sanitation <br /> 20 HSC 119311() Safe machine design ❑V ❑COS <br /> 21 HSC 1193-1(11 Machines cleaned and disinfected between clients ❑V E:COS <br /> 22 HSC 1193'1(3) Parts replaced between clients-grommets,elastic bands.etc. r;V COS <br /> Preventing Cross Contamination <br /> 23 HSC 119309 Workstation/procedure area decontaminated ❑V E COS <br /> 24 HSC 119301(k) Appropriate chemical disinfectant used ❑V E COS <br /> FA0026192 PRO546258 SCO02 07/22/2021 <br /> EHD Rev.6/15/2021 Page 1 of 4 Body Art OIR <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br />