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Facility Name Address City Zip Code Salon De Bellezza 5940 pacific ave Stockton 95207 Name of Permit/Registration Holder Permit Exp. Date Time In Time Out Inspection Type Lorlie Ty Consultation The above facility is inspected for compliance with Division 104, Part 15, Chapter 7 of California Health and Safety Code (HSC). V = Violation C = Corrected On Site V CLEANING AND STERILIZATION C V MACHINE SAFETY AND SANITATION cont C ❑ 1 Autoclave: approved and effective - passed integrator Parts replaced between clients - grommets, elastic bands, test ❑ ❑ 22' etc. El Body Art Inspeco Report • ❑ San Joaquin County Environmental Health Department 1868 E. Hazelton Ave., Stockton, CA 95205 Date: Program g SRVv (Jy y \� '• 3. Record: ❑ \ �__FgRia` (209) 468-3420 www.sjogv.org/ehd Program Element: 1 �/ Facility Name Address City Zip Code Salon De Bellezza 5940 pacific ave Stockton 95207 Name of Permit/Registration Holder Permit Exp. Date Time In Time Out Inspection Type Lorlie Ty Consultation The above facility is inspected for compliance with Division 104, Part 15, Chapter 7 of California Health and Safety Code (HSC). V = Violation C = Corrected On Site V CLEANING AND STERILIZATION C V MACHINE SAFETY AND SANITATION cont C ❑ 1 Autoclave: approved and effective - passed integrator Parts replaced between clients - grommets, elastic bands, test ❑ ❑ 22' etc. El 2. Items washed, disinfected, packaged, labeled, and sterilized ❑ PREVENTING CROSS -CONTAMINATION ❑ 3. Autoclave loaded correctly/packages allowed to dry ❑ ❑ 23. Workstation/procedure area decontaminated ❑ ❑ 4. Integrators used/monthly spore test/log maintained ❑ ❑ 24. Appropriate chemical disinfectant used ❑ ❑ 5 Decontamination/sanitation area separated and supplied appropriately ElChemical used: Sani-cloth ® 6. Invoices and log kept for disposable, pre -sterilized equipment El® 25. Disinfectant used appropriately/sufficient contact time Elappropriately ® 7 Sharps containers labeled, used, and disposed of ❑ Wet contact time provided: 30 secs, 10 mins for HIV ❑ 8 Jewelry, tattoo and piercing equipment - clean and sterilized ❑ El26. Barriers used ❑ PRACTITIONER HEALTH AND HYGIENE ® 27 Products applied to skin are single use/dispensed aseptically ❑ ❑ 9. No eating, drinking or smoking - clean clothes ❑ ❑ 28. Storage of inks, pigments, needles, tubes, etc. ❑ ❑ 10. Hands washed effectively and timely ❑ ❑ 29. Jewelry, Inks, Needles etc approved and used correctly ❑ ® 11. Handwashing facilities properly supplied and accessible, warm water 1:1 El 30'I Cross -contamination avoided during all phases of procedure ❑ ❑ 12. Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES ❑ 13. Bloodbome Pathogen trainingEl❑ 31. Areas separated/no living or sleeping quarters ❑ Source: ® 32. Floors and walls clean and in good repair, adequate light El El Appropriate personal protective equipment available and used El❑ 33 Workstation, surfaces, including chairs, armrests, etc. in ood re air ❑ ' CUSTOMERS/CLIENTS ® 34. Permit/registration posted ❑ ❑ 15. Branding is completed with no other customers in rocedure area ❑ 35. Operation and employee training records present16. Customers eighteen (18) years of age or older ElCOMPLIANCE ro AND ENFORCEMENT ❑ 17. Skin adequately prepared for procedure ❑ 36. Plan(s) submitted for review ❑ ® 18 Client records approved and available - Consent form and questionnaire ❑ ❑ 37. Permits obtained and available ❑ ® 19. Appropriate aftercare instructions given to client ❑ ❑ 38. Impoundment ❑ MACHINE SAFETY AND SANITATION ❑ 39. Hearing scheduled ❑ ❑ 20. Safe machine design ❑ El 40. Closure El ❑ 21. Machines cleaned and disinfected between clients ❑ ❑ 41. ❑ Received b (Print): Lorlie Ty Received by (Signature): Phone: 209 644-8111 Specialist (Print): Mai Vue Specialist (Signature): Phone: (209) 468-3284 Reinspecion oniabout: A reinspection fee of $152 per hour may be charged. Page 1 of 3 EH -11/17