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SA aQQ N Environmental Health Department <br /> LpCarr A <br /> Body Art Inspection Report <br /> Facility Name : Date : <br /> AUTHENTIC IMAGES TATTOO & PIERCING LLC (VEGA , ALCIRA) June 25 , 2021 <br /> Facility Address : Facility Phone: Program Record: <br /> 2139 JACKSON AVE , ESCALON , CA 95320 ( 209 ) 968- 1536 PR0546103 <br /> Permit Holder: Permit Expiration Date: <br /> PADILLA-VEGA , ALCIRA I June 30 , 2022 <br /> Inspection Type: Program : <br /> ROUTINE INSPECTION - Operating Permit 4120 - BODY ART FACILITY-SINGLE USE <br /> The above facility is inspected for compliance with Division 104 , Part 15 , Chapter 7 of the California Health and Safety Code (HSC) . <br /> V = Violation COS = Corrected on site <br /> Cleaning and Sterilization <br /> 1 HSC 119315 (b) Autoclave : approved and effective - passed integrator test ❑ V ❑ COS <br /> 2 HSC 119309 , Items washed , disinfected , packaged , labeled , and sterilized ❑ V ❑ COS <br /> 119315(a) <br /> 3 HSC 119315(b) Autoclave loaded correctly/packages allowed to dry ❑ V ❑ COS <br /> 4 HSC 119315(b) Integrators used/monthly spore test/log maintained ❑ V ❑ COS <br /> 5 HSC 119314(c) Decontamination/sanitation area separated and supplied appropriately ❑ V ❑ COS <br /> 6 HSC 119315 (f) Invoices and log kept for disposable , pre-sterilized equipment ■ V ❑ COS <br /> 7 HSC 119314 (e) Sharps containers labeled , used , and disposed of appropriately ❑ V ❑ COS <br /> 8 HSC 119310 Jewelry, tattoo and piercing equipment - clean and sterilized ❑ V ❑ COS <br /> Practitioner Health and Hygiene <br /> 9 HSC 119309 No eating , drinking or smoking - clean clothes ❑ V ❑ COS <br /> 10 HSC 119308(a) Hands washed effectively and timely ❑ V ❑ COS <br /> 11 HSC 119314(b) Handwashing facilities properly supplied and accessible , warm water ❑ V ❑ COS <br /> 12 HSC 119306 (c) Hepatitis B vaccination ❑ V ❑ COS <br /> 13 HSC 119307 Bloodborne Pathogen training ❑ V ❑ COS <br /> 14 HSC 119308(a) Appropriate personal protective equipment available and used ❑ V ❑ COS <br /> Customers/Clients <br /> 15 HSC 1193090) Branding is completed with no other customers in procedure area ❑ V ❑ COS <br /> 16 HSC 119302 Customers eighteen ( 18) years of age or older ❑ V ❑ COS <br /> 17 HSC 119308(a) Skin adequately prepared for procedure ❑ V ❑ COS <br /> 18 HSC 119303 Client records approved and available - Consent form and questionnaire ■ V ❑ COS <br /> 19 HSC 119308(b) Appropriate aftercare instructions given to client ❑ V ❑ COS <br /> Machine Safety and Sanitation <br /> 20 HSC 119311 (i) Safe machine design ❑ V ❑ COS <br /> 21 HSC 119311 ( h ) Machines cleaned and disinfected between clients ❑ V ❑ COS <br /> 22 HSC 119311 (g ) Parts replaced between clients - grommets , elastic bands , etc. ❑ V ❑ COS <br /> Preventing Cross Contamination <br /> 23 HSC 119309 Workstation/procedure area decontaminated ❑ V ❑ COS <br /> 24 HSC 119301 (k) Appropriate chemical disinfectant used ❑ V ❑ COS <br /> FA0026071 PRO546103 SCO01 06/25/2021 <br /> EHD Rev. 6/15/2021 Page 1 of 3 Body Art 0IR <br /> 1868 E . Hazelton Avenue Stockton , California 95205 1 T 209 468 - 3420 1 F 209 464 -0138 1 www . sjgov . org/ EHD <br />