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EHD Program Facility Records by Street Name
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4100 – Safe Body Art
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PR0546258
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COMPLIANCE INFO
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Entry Properties
Last modified
3/5/2025 3:30:14 PM
Creation date
4/18/2023 11:18:11 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4100 – Safe Body Art
File Section
COMPLIANCE INFO
RECORD_ID
PR0546258
PE
4120 - BODY ART FACILITY-SINGLE USE
FACILITY_ID
FA0026192
FACILITY_NAME
OLD VINE TATTOO (PALMER, JOSH)
STREET_NUMBER
521
Direction
W
STREET_NAME
KETTLEMAN
STREET_TYPE
LN
City
LODI
Zip
95242
CURRENT_STATUS
Inactive, non-billable
QC Status
Approved
Scanner
SJGOV\cfield
Supplemental fields
Site Address
521 W KETTLEMAN LN LODI 95242
Tags
EHD - Public
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Address: Old Vine Tattoo— 521 W Kettleman Ln, Stockton, CA 95242 Record ID: PR0546258 <br /> Date: 7/27/21 <br /> PHOTO 5: Sterilization certificate for instrument. <br /> WWW.BLAG KCLAW.GOM <br /> t c7C1 3 A(EO-Sterilization Batch Report) <br /> Furnace Noma 7: Y1-01 Sterilization NO TffiAt: #200901 Date 171141: 2020-09-26 <br /> Article Name Production No Specification Quantity Remark Parameters During Sterilization Cycle Requred Actual <br /> "1't'i f'Yr4iR3r.` Sia:No <br /> TATTOO NEEDU <br /> 31::ek i' F -?(i0'dtJl ''.!hNz2 rX 4'P 64CENS ;kl#1'''�'RChamber Temperature while Stenlization(Vi 47 53S 4R E. 52.6 <br /> f111T"Till.� � <br /> (Mffi,)Chamber Pressure while Stenlization(kPa) 30--20 5 -27.1 E 15.5 <br /> skMJftChamber Humidity while Sterilization(%RH) 40-80 33.5-52.8 ; <br /> XMIIJWExposure time(min) 480 480 , <br /> RA!?tTPre-Vacuum Value(kPa) <br /> ml i3@ 1fj1 Q 11 Pressure Amplitude while Humidifying(kPa) <br /> MiRAt 0,EE�1Pressure Changed while Humidifying(kPa) <br /> ho1h]Eh44.1Pressure Amplitude while EO Injection(kPa) <br /> ,Jpn ( [t))Pressure Changed while EO Injection(kPa) ;/ S:-69 2 L: a5.2 <br /> UI1�i C(#Weight of EO used(kg) 8-4.2 12 <br /> Sterilization Phase Start Time End Time Actual Time Sterilization Information Release <br /> lltlil �01"91fal �S�Irifull k�Ht(u7 k k 1SC KIN <br /> A?! Conditioning 9: 17 13: 17 2240 Normal ll:m Passed s � <br /> 111111 ) Air Removal I'3: 17 1'1- 94 Normal 1-17 Rejected V$( <br /> f Jtft,li� Pressure Time 13: 24 13: 29 5 Normal 31":n Hold P$ SE <br /> i <br /> frhEO EO Injection 13: 35 13: 50 15 Normal '; L• <br /> Inj cror)III?4i tor$a4k v: <br /> 9M14(u1 Exposure Time 13: 50 21: 50 480 Normal <br /> 10'!01(b7 EO Removal 21: 50 2'2: 16 26 '� \r E Mangerk 'r: <br /> iAIn-1P Finishing 22: 16 22: 58 32 <br /> Mic Lab Mangerflan <br /> �k Q anager' <br /> Pinne Chao, Environmental Health Specialist Page 5 of 12 <br />
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