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Body Art Inspeds Report • Date: .� San Joaquin County Environmental Health Department Program 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: (209)468-3420 Program Fo_ a www.siogv.org/ehd U Element: Facility Na e Address City Zip Code r 16 "LL Name of Permit/Registration Holder Permit Exp.Date Time In Time Out Inspection Type Ui'lk b(W4 co LO) ✓ASkj r Go The above facility is inspected for compliance with Division 104, Part 15,Chapter 7 of Californih Health and Safety Code SC). 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 ❑ ❑ 22 Parts replaced between clients-grommets,elastic bands, Eltest etc. ❑ 2 Items washed,disinfected,packaged,labeled,and sterilized El 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 Decontamination/sanitation area separated and supplied ❑ ❑ 5. E] Chemical used: appropriately ® 6 Invoices and log kept for disposable,pre-sterilized equipment ElEl25. Disinfectant used appropriately/sufficient contact time El® 7 Sharps containers labeled,used,and disposed of ElWet contact time provided: appropriately ❑ 8 Jewelry,tattoo and piercing equipment-clean and sterilized El El26. Barriers used E) ❑ 27 Products applied to skin are single use/dispensed ElPRACTITIONER HEALTH AND HYGIENE ase tical) ❑ 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, Cross-contamination avoided during all phases of ❑ warm water El ❑ 30' procedure ❑ 12. Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES ❑ 13. Bloodborne Pathogen training ❑ ❑ 31. Areas separated/no living or sleeping quarters ❑ Source: ® 32. Floors and walls clean and in good repair,adequate light ❑ ❑ Appropriate personal protective equipment available and Workstation,surfaces,including chairs,armrests,etc.in El14. used El ® 33. good repair CUSTOMERS/CLIENTS ❑ 34. Perm ittregistration posted ❑ Branding is completed with no other customers in [j 15. rocedure area El El 35. Operation and employee training records present E] ❑ 16. Customers eighteen(18)years of age or older ❑ COMPLIANCE AND ENFORCEMENT ❑ 17. Skin adequately prepared for procedure ❑ ® 36. Plan(s)submitted for review ❑ ® 18 Client records approved and available-Consent form and uestionnaire El ® 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 ❑ ❑ 40. Closure ❑ ❑ 21. Machinescleanedand/disinfected between clients El 1141. ❑ Received b Print): 1�� c^^^ A1x Iyx Received by(Signature): Phone: N 75 Specialist(Print): Specialist(Signature): Phone: Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Page 1 of 3 EH-11/17