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"S" A N J 0 A 0 N (N Environmental Health Department f Y Body Art Inspection Report F&.lity name: Facility Address: Date: OLD VINE TATTOO('F.LMER, JOSH) ` 21 VV KETTLEMAN LN. LODI July 22 2021 Preventing Cross Contamination 2:. HSC 119309(b) Disinfectant used appropriately/sufficient contact time ❑V ❑COS 26 HSC 119311(h) Barriers used ❑V ❑COS 2: HSC 119311(a) Products applied to skin are single use/dispensed aseptically ❑V ❑COS 28 HSC 119315 Storage of inks,pigments,needles,tubes,etc. ❑V ❑COS 29 HSC 119310, 119311 Jewelry, Inks, Needles etc approved and used correctly ❑V ❑COS 30 HSC 119309 Cross-contamination avoided during all phases of procedure ❑V ❑COS Best Business Practices 3, HSC 119314 Areas separated/no living or sleeping quarters ❑V ❑COS 32 HSC 119314, 119317 Floors and walls clean and in good repair,adequate light ■V ❑COS 33 HSC 119314 Workstation,surfaces,including chairs,armrests,etc.in good repair ■V ❑COS 34 HSC 119303, 119312 Permit/registration posted ❑V ❑COS 35 HSC 119313 Operation and employee training records present ■V ❑COS Compliance and Enforcement 36 HSC 119312 Plan(s)submitted for review ❑V ❑COS 37 HSC 119312, 1193C6 Permits obtained and available ■V ❑COS 33 HSC 119319 Impoundment ❑V ❑COS 33 HSC 119320 Hearing scheduled ❑V ❑COS 4) HSC 119320 Closure ❑V ❑COS Other Violations 41 See below Other violations ❑V ❑COS OBSERVATIONS AND CORRECTIVE ACTIONS Item# Remarks HSC 119315(f) 1 ivoices and log kept for disposable, pre-sterilized equipment. A facility that uses single use instruments shall maintain record of purchase, log of procedures, names of practitioner and client, date of procedure, instruments used, and written evidence from the manufacture that the instruments havB undergone sterilization. The record of purchase, evidence of sterilization, type and number of instrurrents usel shall be maintained for a minimum of 90 da 9315(f) -Invoices an terilization certificate was not available for the following nee s7and fsterilizatio K CLAW LOT#200901 TATSOUL LOT 00501, and TATSOU LOT#201201. Provide EHD with invoi certifrcat€ r the entioned instrun- nts. U15(,6tv0k- VSZ HSC 1'9314(---) Sharps containers labeled, used, and disposed of appropriately. The sharps waste container shall be within arm's reach and labeled with the word "sharps waste" or with the biohazard synbol and the word"Biohazard". Sharp waste containers shall be disposed by a licensed waste hauler or approved ma I back system. Documentation of proper disposal shall be maintained for 3 years. HSC 119314(e)- Provide proof of sharps disposal record to EHD. 1 13rr,�c� �r�Otcr.�, S%Oc � , cHFCir 1150ti, III✓ 2 0%K1 FA0026192 PRO546258 SCO02 07122/2021 EHD Rev.6/15/2021 Page 2 of 4 Body ArtOIR 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD l�