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Specialist (Print): Specialist (Signature): Phone: <br />❑This report is an Official Notice of Violation. Corrections must be completed in the time specified. <br />A reinspection fee may be charged if violations noted on this report are not corrected by the reinspection date. Reinspection Date (on or about) <br />Paged -of J_ <br />u H Date (MMIDD/YY) <br />o ro Body Art Inspection Report <br />y County of San Joaquin County, Environmental Health Department <br />Permit Number r 5 <br />1868 E. Hazelton Ave., Stockton CA 95205 <br />�•� (209) 468-3420 www.sigov.org/ehd <br />� Permit Type <br />a � <br />Po <br />Facility Name Address City Zip Code CT <br />T-vr,✓ ��� ' i c1 -trt� 6011 (10 i I r'" `�1- . ' i fZk-'r 4 4 "53 <br />Permit/Registration Holder Name Permit Exp. Datj Total Time Inspection pe <br />u,1 <br />6 /30 / J3 z vin ; A <br />RISK FACTORS AND INTERVENTIONS <br />Risk factors are improper practices or procedures identified <br />as contributing factors of cross -contamination. <br />Interventions are control measures to prevent cross -contamination <br />and transfer of pathogens from one person to another. <br />In = In Compliance Out = Not in Compliance N/O = Not <br />Observed <br />N/A = Not Applicable COS = Corrected On Site <br />e ; TATTOO AND KWANENT COSMETICS MACHINE <br />CLEANING AND STERILIZATION our cos <br />SAFETY AND SANITATION OUT cos <br />In N/0 <br />1. Autoclave is approved and effective - passed <br />0 <br />0 <br />In N/O <br />18. Safe machine design <br />0 <br />0 <br />NIA <br />integrator test <br />NIA <br />In NIO <br />2. Process of cleaning, labeling, packaging and <br />0 <br />In N/O <br />19. Machines cleaned and disinfected between <br />0 <br />0 <br />NIA <br />sterlizling items correctly <br />NIA <br />clients <br />In N/0 <br />3. Autoclave loaded correctly/packages allowed to <br />0 <br />0 <br />In N/0 <br />20. Parts replaced between clients - grommets, <br />0 <br />0 <br />NIA <br />dry <br />N/A I <br />elastic bands, etc. <br />In NIO <br />4. Integrators used/monthly spore test/log <br />PREVENTING CROSS= CONTAMINATION <br />N/A <br />maintained"" <br />In NIO <br />5. Decontamination/sanitation area separate and <br />0 <br />0 <br />In N/0 <br />21. Workstation/procedure area decontaminated <br />0 <br />0 <br />NIA <br />supplied * <br />NIA <br />In N/0 <br />6. Invoices and log kept for disposable, pre- <br />0 <br />0 <br />In N/0 <br />22. Chemical disinfectant used <br />0 <br />0 <br />NIA <br />sterilized equipment, backu supplies available * <br />NIA <br />Chemical used: <br />In N/O <br />7. Sharps containers supplied, labeled, used and <br />0 <br />0 <br />In N/O <br />23. Disinfectant used sufficient contact time Wet <br />0 <br />0 <br />N/A <br />disposed of correct) * <br />N/A <br />contact timeprovided: <br />In NIO <br />8. Jewelry, tattoo and piercing equipment - storage <br />0 <br />0 <br />In N/O <br />24. Barriers available and used as part of <br />0 <br />0 <br />NIA <br />and use <br />N/A <br />procedure <br />In N/0 <br />25. Products applied to skin are single <br />0 <br />0 <br />PRACTITIONER HEALTH AND HYGIENE <br />N/A <br />use/dispensed aseptically <br />In N/0 <br />9. No eating, drinking or smoking - clean clothes <br />0 <br />0 <br />In N/0 <br />26, Storage of inks, pigments, needles, tubes, etc., <br />0 <br />13 <br />NIA <br />NIA <br />In N/0 <br />10. Hands washed effectively and timely <br />0 <br />0 <br />In N/0 <br />27. Jewelry, Inks, Needles etc approved and used <br />0 <br />0 <br />N/A <br />NIA <br />In N10 <br />11. Handwashing facilities properly supplied and <br />0 <br />11 <br />In N/0 <br />28. Cross -contamination avoided during all phases <br />0 <br />0 <br />N/A <br />accessible, warm potable water * <br />NIA <br />of procedure <br />In N/O <br />12. Personal protective equipment available and <br />0 <br />0 <br />BEST BUSINESSPRACTICES <br />NIA <br />used, eyewash station available <br />CIJSTOMENSICUEN 9�, <br />In NIO <br />29. Areas separated/no living or sleeping <br />El <br />11 <br />: " <br />N/Aquarters/no <br />animals * <br />In N/0 <br />13. Branding is completed with no other customers in <br />0 <br />0 <br />In NIO <br />30. Floors and walls clean and in good repair, <br />0 <br />0 <br />N/A <br />procedure area <br />N/A <br />adequate light * <br />In NIO <br />14. Customers eighteen (18) years of age or older <br />0 <br />0 <br />In NIO <br />31. Workstation, surfaces, including chairs, , etc. in <br />0 <br />0 <br />N/A <br />NIA <br />good repair, trash removed frequently * <br />In NIO <br />15. Skin prepared for procedure. <br />0 <br />0 <br />In N/O <br />32. Pennit/registration and required signs posted * <br />0 <br />0 <br />NIA <br />N/A <br />In N/O <br />16. Client records available - Consent form & <br />0 <br />0 <br />In N/0 <br />33. IPCP and employee training records and <br />0 <br />0 <br />NIA <br />questionnaire <br />NIA <br />He atitiis B vaccination status present <br />In N/0 <br />17. Aftercare instructions given to client <br />0 <br />0 <br />In N/0 <br />34 Restrooms available, stocked * <br />0 <br />0 <br />N/A <br />NIA <br />Received by (Print): SP[; 2jrjSL }Cam' Received by (Signature): Phone: <br />Specialist (Print): Specialist (Signature): Phone: <br />❑This report is an Official Notice of Violation. Corrections must be completed in the time specified. <br />A reinspection fee may be charged if violations noted on this report are not corrected by the reinspection date. Reinspection Date (on or about) <br />Paged -of J_ <br />