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f `UIN-� d <br /> ¢,'oP Fo Body Art Inspect Report . Date: <br /> San Joaquin County Environmental Health Department Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: S KONO& <br /> (209)468-3420 Program <br /> www.siogv.org/ehd Ll 103 <br /> Element: <br /> Facility Name Address City Zip Code <br /> -6eht6e4en 14 R iyvs y (s-�dd a 37 w yokuts ave Stockton 95207 <br /> Name of Permit/Registration Holder Permit Exp.Date Time In Time Out Inspection Type <br /> Ludda Her 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 integratorParts replaced between clients-grommets,elastic bands, Eltest E] ❑ 22. etc. <br /> ❑ 2 Items washed,disinfected,packaged,labeled,and <br /> sterilized El CROSS-CONTAMINATION <br /> ❑ 3. Autoclave loaded correctly/packages allowed to dry ❑ ❑ 23. Workstation/procedure area decontaminated ❑ <br /> ❑ 4. Integrators used/monthly spore testilog maintained ❑ ❑ 24. Appropriate chemical disinfectant used <br /> ❑ 5 Decontamination/sanitation area separated and supplied Elappropriately El Chemical used: <br /> ® 6 Invoices and log kept for disposable,pre-sterilized <br /> equipment El El25. Disinfectant used appropriately/sufficient contact time <br /> ® 7 Sharps containers labeled,used,and disposed of Ela ro riatel El Wet contact time provided: <br /> ❑ 8 Jewelry,tattoo and piercing equipment-clean and <br /> El 26. Barriers used Elsterilized <br /> ❑ 27 Products applied to skin are single use/dispensed ❑ <br /> PRACTITIONER HEALTH AND HYGIENE aseptically <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 El 30" El procedure <br /> ❑ 12. Hepatitis B vaccination ❑ <br /> BEST BUSINESS PRACTICES <br /> ® 13. Bloodborne Pathogen trainingEl ❑ 31. Areas separated/no IryE]ing or sleeping quarters <br /> Source: Biologix ❑ 32. Floors and walls clean and in good repair,adequate light ❑ <br /> ❑ 14. Appropriate personal protective equipment available and Workstation,surfaces,including chairs,armrests,etc.in <br /> used El El 33' E3 good repair <br /> CUSTOMERS/CLIENTS ® 34• Perm ittregistration posted ❑ <br /> ❑ 15 Branding is completed with no other customers in <br /> procedure area El ® 35. Operation and employee training records present ❑ <br /> ❑ 16. Customers eighteen(18)years of age or older ❑ 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 El 37. Permits obtained and available El <br /> and <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 by(Print): Ludda Her Received by(Signature): I L Phone:(209)471-6064 <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 />