Laserfiche WebLink
�Lrr <br /> Body Art Inspeca Report Date: <br /> Z San Joaquin County Environmental Health Department <br /> { Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 (fin <br /> (209)468-3420 Record:Program \" 53101 <br /> �,yFo www.sioay.org/ehd <br /> Element: , 1 _0 <br /> Facility Name Address City Zip Code <br /> Forever Yours Tattoo 606 w. 11'h st. Tracy 95376 <br /> Name of Permit/Registration Holder Permit Exp.Date Time In Time Out Inspection Type <br /> John Hullar 6/30/16 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 El Parts replaced between clients-grommets,elastic bands, ❑ <br /> test El 22' etc. <br /> ❑ 2 Items washed,disinfected,packaged,labeled,and <br /> 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 ❑ [j 24. Appropriate chemical disinfectant used <br /> El 5 Decontamination/sanitation area separated and supplied ❑ <br /> appropriately ❑ Chemical used: <br /> ® 6 Invoices and log kept for disposable,pre-sterilized <br /> equipment ❑ ❑ 25. Disinfectant used appropriately/sufficient contact time <br /> ❑ 7 Sharps containers labeled,used,and disposed of ❑ <br /> ElWet contact time provided: <br /> appropriately <br /> ❑ 8 Jewelry,tattoo and piercing equipment-clean and <br /> ❑ ® 26. Barriers used ❑ <br /> sterilized <br /> ❑ 27 Products applied to skin are single use/dispensed 11PRACTITIONER HEALTH AND HYGIENE aseptically <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 E] <br /> El Handwashing facilities properly supplied and accessible, Cross-contamination avoided during all phases of ❑ <br /> warm water ❑ 01 30. Procedure <br /> ❑ 12. Hepatitis B vaccination ❑ <br /> BEST BUSINESS PRACTICES <br /> ❑ 13. Bloodborne Pathogen training ❑ rEE11 <br /> 31. Areas separated/no living or sleeping quarters E]Source: 32. Floors and walls clean and in good repair,adequate light 1:114 Appropriate personal protective equipment available and Workstation,surfaces,including chairs,armrests,etc.inused El 33' ood re air El <br /> CUSTOMERS/CLIENTS ❑ 34. Perm it/registration posted ❑ <br /> ❑ 15. Branding is completed with no other customers in <br /> procedure area El El35. Operation and employee training records present ❑ <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 /> ❑ 18 Client records approved and available-Consent form <br /> and uestionnaire ❑ 37. Permits obtained and available <br /> ❑1 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 ❑ ❑ 41. / ❑ <br /> Received b (Print): John Hullar Received by(Signature): Phone: 209 830-6164 <br /> Specialist(Print): Benjamin Escotto,Sr REHS Specialist(Signature): Phone: 209 468-3178 <br /> Reinspecion onlabout: A reinspection fee of$130 per hour may be charged. Page 1 of 2 <br /> EH-03/2015 <br />