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>Pa The a)ove facility is inspected for compliance with Division V = Violation 104, C Body Art Inspection Report Date: 10/4/22 4 San Joaquin County Environmental Health Department V CLEANING AND STERILIZATION Program V 1368 E. Hazelton Ave., Stockton, CA 95205 Record: SR0085863 (209)468-3420 `C Program E] • �P� www.sioov.orp/ehd Element: 4103 El =acility Dame Address City Zip Code _ost Dreams Tattoo and Piercing 5920 Pacific Ave Stockton 95207 Narre of Permit/Registration Holder Permit Exp. Date Time In Time Out Inspection Type Mictael Carter ❑ Consultation Reinspection on/atout: A reinspection fee of $156 per hour may be charged. Page 1 of 4 EH -11/17 The a)ove facility is inspected for compliance with Division V = Violation 104, Part 15, C = Chapter 7 of California Health and Safety Code (HSC). Corrected On Site V CLEANING AND STERILIZATION C V MACHINE SAFETY AND SANITATION (cont.) C 1. Autoclave: approved and effective -passed integrator test E] E]22. Parts replaced between clients - grommets, elastic bands, etc. El ] 2' Items was ied, disinfected, packaged, labeled, and sterilized E]PREVENTING CROSS -CONTAMINATION ] 3. Autoclave loaded correctly/packages allowed to dry ❑ ❑ 23. Workstation/procedure area decontaminated ❑ Z 4. IntegratoE used/monthly spore test/log maintained ❑ ❑ 24. Appropriate chemical disinfectant used ❑ 5. Decontam nation/sanitation area separated and supplied appropriately ❑ Chemical used: 6 Invoices aid log kept for disposable, pre -sterilized e ui mert El El 25. Disinfectant used appropriately/sufficient contact time ❑ 7' Sharps coitainers labeled, used, and disposed of a ro riat?I E] et contact time provided: ] 8 Jewelry, IFttoo and piercing equipment - clean and sterilized ❑ ❑ 26. Barriers used ❑ PRACTITIONEP. HEALTH AND HYGIENE ❑ 27. Products applied to skin are single use/dispensed aseptically ❑ ] 9. No eatinc, 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. Handwas ing facilities properly supplied and accessible, hot water El El30. Cross -contamination avoided during all phases of procedure ❑ ❑ 12. Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES ❑ 13. Bloodbor-e Pathogen training ❑ ❑ 31. Areas separated/no living or sleeping quarters ❑ Source: ® 32. Floors and walls clean and in good repair, adequate light ❑ ❑ 14. AppropriElpersonal protective equipment available and used Ele ❑ 33. Workstation, surfaces, including chairs, armrests, etc. in good repair El CUSTOM ERS/C _IENTS ® 34. Permit/registration posted ❑ ❑ 15. Branding s completed with no other customers in rocedure area ❑ ® 35. Operation and employee training records present E] ❑ 16. Custome-s eighteen (18) years of age or older ❑ COMPLIANCE AND ENFORCEMENT ❑ 17. Skin adeq-jately prepared for procedure [:1 ❑ 36. Plan(s) submitted for review ❑ ❑ 18. Client records approved and available - Consent form and ❑ ® 37. Permits obtained and available 1:1uestionsaire ❑ 19. Appropria-e aftercare instructions given to client ❑ 38. Impoundment E]MAC � MACHINE SAFY AND SANITATION rEl El 39. Hearing scheduled E] El Safe machine design ❑ 40. Closure ❑ F121. Machines cleaned and disinfected between clients ❑ ❑ 41. ❑ roe Received b (Print): Michael Carter Received by (Signature): Phone: 209-696-5757 ,tip Specialist (Print): P ane Chao Specialist (Signature): Phone: 209-468-3854 Reinspection on/atout: A reinspection fee of $156 per hour may be charged. Page 1 of 4 EH -11/17