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H. List the Medical Waste Hauler, Mail -Back System or Alternative Treatment Technology for <br />the disposal of sharps containers: <br />(California Health and Safety Code 119314 (e)) <br />Medical Waste Hauler <br />Street Address <br />City, ST, Zip <br />I. Sterilization of Jewelry: Describe the procedure for the sterilization of jewelry prior to placing into <br />newly pierced sn. (California Health and Safety Code 119310 (a) and 119315) <br />P '(�r <br />J. Sterilization Equipment: List the equipment used in the decontamination and sterilization room <br />and describe the procedure for decontaminating instruments prior to placing inside the autoclave. <br />Indicate whether instruments are manually washed or machine washed, such as with an <br />Ultrasonic machine. Include the material used for soaking dirty instruments in the machine, <br />such as Tergazyme. (California Health and Safety Code 119309 (b)(e)(g), 119314 (c), and <br />119315 (b)) n 1 <br />K. Disinfection Products: List the disinfectant products used at the body art facility. (California <br />Health and Safety Code 119301 (k) and 119308 (b)(6)) <br />M kVA -C I D15 <br />L. Time and Temperature: List the duration of time and temperature of the autoclave required for <br />the sterilization of clean instruments. Indicate whether a sterilization log is maintained on-site. <br />Indicate whether each sterilization load is tested using Class 5 integrators. (California Health and <br />Safety Code 119315 (b)(3)(5)) <br />Time <br />Temperature <br />Psi <br />M. Personal Protective Equipment: List the personal protective equipment used during a body art <br />procedure. (California Health and Safety Code 119308 (a) and 119309 Q)) <br />Page 5 of 10 <br />