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I � <br /> Body Art Inspect* Report Date: /Z/Zo►g <br /> San Joaquin County Environmental Health Department <br /> Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 g p <br /> (209)468-3420 Record: J11tw l(� <br /> • c9�;•••.'�`P www. oqv orq/ehd Program <br /> s <br /> Foa. i Element: L2 <br /> Facility Name Address City Zip Code <br /> Forever Yours Body Art 3422 w.hammer lane suite m Stockton 95219 <br /> Name of Permit/Registration Holder Permit Exp.Date Time In Time Out Inspection Type <br /> John Hullar Final/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 ❑ [j 22 Parts replaced between clients-grommets,elastic bands, E]test etc. <br /> ❑ <br /> Items washed,disinfected,packaged,labeled,and 2. sterilized El CROSS-CONTAMINATION <br /> ❑ 3. Autoclave loaded correctly/packages allowed to dry ❑ ❑ 23. Workstation/procedure area decontaminated ❑ <br /> ❑ 4. Integrators used/monthly spore test/log maintained ❑ ❑ 24. Appropriate chemical disinfectant used <br /> Decontamination/sanitation area separated and supplied E]❑ 5' a ro riatel ElChemical used: Opticide <br /> ❑ <br /> Invoices and log kept for disposable,pre-sterilized 6" equipment El El25. Disinfectant used appropriately/sufficient contact time <br /> Sharps containers labeled,used,and disposed of ❑ <br /> El 7" a ro riatel El Wet contact time provided: 3 mins <br /> El 8 Jewelry,tattoo and piercing equipment-clean and El ❑ 26. Barriers used E]sterilized <br /> Products applied to skin are single use/dispensed <br /> PRACTITIONER HEALTH AND HYGIENE [1 27' asepticallyEl <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 /> ❑ <br /> Handwashing facilities properly supplied and accessible, Cross-contamination avoided during all phases of 11. warm water El ❑ 30 rocedure ❑ <br /> ❑ 12. Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES <br /> ❑ 13. Bloodborne Pathogen training ❑ ❑ 31. Areas separated/no living or sleeping quarters ❑ <br /> Source: Biologix ❑ 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 /> F1 14. used ❑ ❑ 33" good repair <br /> El <br /> CUSTOMERS/CLIENTS ❑ 34. Perm it/registration posted ❑ <br /> Branding is completed with no other customers in <br /> El 15. ❑ ❑ 35. Operation and employee training records present Elrocedure 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 /> ❑ <br /> Client records approved and available-Consent form 18. questionnaire <br /> El F1 37. Permits obtained and available Eland <br /> El 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 I ❑ r1_5 41. ❑ <br /> Received b (Print): John Hullar Received by(Signature): , hone: 209 407-0250 <br /> Specialist(Print): Har rit Mattu,Sr REHS Specialist(Signature)7 &A& Phone: 209 468-3284 <br /> Reinspecion on/about: A reinspection fee of$130 per hour may be charged. Page 1 of 2 <br /> EH-0312015 <br />