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PCV!N',' O` Body Art Inspece Report Date: <br /> `-2 San Joaquin County Environmental Health Department <br /> eeaProgram <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: <br /> c P (209)468-3420 ram Pro <br /> gCrFaRa` www.siogv.org/ehd g <br /> Element: 1 <br /> Facility Name Address City Zip Code <br /> Tall Tales Tattoo 7170 west lane ste 4 Stockton 95210 <br /> Name of Permit/Registration Holder Permit Exp. Date Time In Time Out Inspection Type <br /> Christina N.Ramirez Consultation <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 Parts replaced between clients-grommets,elastic bands, <br /> test [I ❑ 22' Eletc. <br /> ❑ 2 Items washed,disinfected,packaged,labeled,and <br /> sterilized El CROSS-CONTAMINATION <br /> [j 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 /> El 5 Decontamination/sanitation area separated and supplied ❑ <br /> appropriately ❑I Chemical used: <br /> ® 6 Invoices and log kept for disposable,pre-sterilized <br /> ui ment El ® 25. Disinfectant used appropriately/sufficient contact time <br /> ® 7 Sharps containers labeled,used,and disposed of El <br /> appropriately ❑ [Wet contact time provided: <br /> ❑ 8 Jewelry,tattoo and piercing equipment-clean and <br /> sterilized El ® 26. Barriers used E] <br /> ❑ 27 Products applied to skin are single use/dispensed E]PRACTITIONER HEALTH AND HYGIENE ase tical) <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 /> ❑ 11 Handwashing facilities properly supplied and accessible, Cross-contamination avoided during all phases of <br /> warm water El ❑ 30' El <br /> ❑ 12. Hepatitis B vaccination ❑ <br /> BEST BUSINESS PRACTICES <br /> ® 13. Bloodborne Pathogen training ❑ ❑ 31. 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 E]used ood repair <br /> CUSTOMERS/CLIENTS ® 34. Permit/registration posted ❑ <br /> ❑ 15. Branding is completed with no other customers in <br /> rocedure area ❑ ® 35. Operation and employee training records present ❑ <br /> ® 16. Customers eighteen(18)years of age or older ❑ <br /> 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 1:1and questionnaire ElEl37. Permits obtained and available <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. ❑ <br /> Received b Print): Christina Ramirez Received by(Signature): Phone: 209 670-4452 <br /> Specialist(Print): Mai Vue Specialist(Signature): ^„�� Phone: (209)468-3284 <br /> Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Page 1 of 3 <br /> EH-11/17 <br />