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Body Art InspectilaReport Date: <br /> San Joaquin County Environmental Health Department Program <br /> 1 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: <br /> \ (209)468-3420 Program <br /> www.siogv.org/ehd Element: J <br /> Facility Name Address City Zip Code <br /> All Ahmit Yni�G•ar Treatment AIR.a ranter at Roantara or 419 <br /> Name of Permit/Registration Holder Permit Exp.Date Time In Time Out Inspection Type <br /> Shelley Kohl 6/30/15 Routine <br /> The above facility is inspected for compliance with Division 104,Part 15,Chapter 7 of California Health and Safety Code(HSC). <br /> V=Violation C=Corrected On Site <br /> V CLEANING AND STERILIZATION C V MACHINE SAFETY AND SANITATION cont. C <br /> ❑ 1 Autoclave:approved and effective-passed integrator ❑ ❑ 22 Parts replaced between clients-grommets,elastic bands, ❑ <br /> test etc. <br /> ❑ <br /> Items washed,disinfected,packaged,labeled,and 2' sterilized 11PREVENTING CROSS-CONTAMINATION <br /> ❑ 3. Autoclave loaded correctly/packages allowed to dry rEl <br /> El 23. Workstation/procedure area decontaminated El <br /> El Integrators usedimonthly spore test/log maintained El24. Appropriate chemical disinfectant used <br /> Decontamination/sanitation area separated and supplied El5. a ro riatel Chemical used: <br /> ® <br /> Invoices and log kept for disposable,pre-sterilized 6• El El25. Disinfectant used appropriately/sufficient contact time <br /> equipment <br /> Sharps containers labeled,used,and disposed of ❑ <br /> ❑ 7' El Wet contact <br /> appropriately <br /> contact time provided: <br /> ❑ 8 Jewelry,tattoo and piercing equipment-clean and ❑ ❑ 26. Barriers used Elsterilized <br /> Products applied to skin are single use/dispensed <br /> PRACTITIONER HEALTH AND HYGIENE ❑ 27. ase tical) El <br /> ❑ 9. No eating,drinking or smoking-clean clothes ❑ ❑ 28. Storage of inks,pigments,needles,tubes,etc. ❑ <br /> ❑ 10. Hands washed effectively and timely ❑ ❑ 29. Jewelry,Inks,Needles etc approved and used correctly ❑ <br /> Handwashing facilities property supplied and accessible, Cross-contamination avoided during all phases of <br /> ® 11' warm water El El 30. procedure <br /> ❑ <br /> ❑ 12. Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES <br /> ❑ 13. Bloodbome Pathogen training ❑ 31. Areas separated/no living or sleeping quarters ❑ <br /> Source: Biologix Solutions ❑ 32. Floors and walls clean and in good repair,adequate light ❑ <br /> Appropriate personal protective equipment available and Workstation,surfaces,including chairs,armrests,etc.in <br /> ❑ 14. used El ❑ 33' good repair ❑ <br /> CUSTOMERS/CLIENTS ❑ 34. Permit/registration posted ❑ <br /> Branding is completed with no other customers in <br /> ❑ 15. F1 ® 35. Operation and employee training records present <br /> procedure area ❑ <br /> ❑ 16. Customers eighteen(18)years of age or older ❑ COMPLIANCE AND ENFORCEMENT <br /> ❑ 17. Skin adequately prepared for procedure ❑ ❑ 36. Plan(s)submitted for review ❑ <br /> Client records approved and available-Consent form <br /> ® 18. El Eluestionnaire 37. Permits obtained and available <br /> and ❑ <br /> ® 19. Appropriate aftercare instructions given to client ❑ ❑ 38. Impoundment ❑ <br /> MACHINE SAFETY AND SANITATION ❑ 39. Hearing scheduled ❑ <br /> ❑ 20. Safe machine design ❑ ❑ 40. Closure ❑ <br /> ❑ 21. Machines cleaned and disinfected between clients ❑ [j41. ❑ <br /> 0 Received b (Print): Shelley Kohl Received by Sionaturel �' VL Phe 4 t0,` <br /> Specialist(Print): Afonso Arambula Specialist(Signature): Phone: 209 468-9673 <br /> Reinspecion on/about: A reinspection fee of$125 per hour ma rged. Page 1 of 2 <br /> EH-04/2014 <br />