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peau'" <br /> Body Art Ins ectlRe ort <br /> a2 Y p P Date: l 0/ 5 I t 9 <br /> �J San Joaquin County Environmental Health Department Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: P iZ0 6 4.& 8`f <br /> (209)468-3420 Program <br /> o4<(FOR�'�P www.slogv.org/ehd Element: <br /> Facility Name Address City Zip Code <br /> Forever Yours Body Art 3422 w hammer lane suite m Stockton 95219 <br /> Name of Perm it/Registration Holder Permit Exp.Date Time In Time Out Inspection Type <br /> John Hullar 6/30/20 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 I etc. <br /> F] 2. Items washed,disinfected,packaged,labeled,and Elsterilized PREVENTING 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 ro <br /> [-1 24. Appropriate chemical disinfectant used 13 <br /> Decontamination/sanitation area separated and supplied Chemical used: <br /> Fl5. appro riatelInvoices and log kept for disposable,pre-sterilized6. El25. Disinfectant used appropriately/sufficient contact timea ui ment El <br /> ® 7 Sharps containers labeled,used,and disposed of ❑ Wet contact time provided: <br /> a ro riatel <br /> Jewelry,tattoo and piercing equipment-clean and E] ❑ 26. Barriers used El <br /> ❑ 8. sterilized <br /> Products applied to skin are single use/dispensed <br /> PRACTITIONER HEALTH AND HYGIENE ❑ 27. aseptically El <br /> 9. No eating,drinking or smoking-clean clothes ❑ ❑ 28. Storage of inks,pigments,needles,tubes,etc. ❑ <br /> F110. Hands washed effectively and timely [:1 El 29. Jewelry, Inks, Needles etc approved and used correctly El <br /> F] Handwashing facilities properly supplied and accessible, ❑ ❑ 30. Cross-contamination avoided during all phases of El <br /> warm water procedure <br /> ❑ 12. Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES <br /> ❑ 13. Bloodborne Pathogen training [Ell ❑ El31. Areas separated/no living or sleeping quarters <br /> Source: ❑ 32. Floors and walls clean and in good repair,adequate light ❑ <br /> ❑ 14. Appropriate personal protective equipment available and ❑ ❑ 33 Workstation,surfaces,including chairs,armrests,etc.in ❑ <br /> usedgood repair <br /> CUSTOMERS/CLIENTS ❑ 34. Permit/registration posted ❑ <br /> Branding is completed with no other customers in <br /> ❑ 15. ❑ ❑ 35. Operation and employee training records present El <br /> rocedure 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 /> ❑ 18 Client records approved and available-Consent form ❑ ❑ 37. Permits obtained and available ❑ <br /> and questionnaire <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 ❑ ❑ 41. IVC�� ❑ <br /> Received b (Print): John Hullar Received b (Signature): hone:209-407-0250 <br /> Specialist(Print): Sandip Singh Specialist(Signature)7 Phone: 209-468-3526 <br /> Reinspecion on/about: A reinspection fee of$152 per hour may be charged. n Page 1 of 2 <br /> EH-11/17 <br />