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Name of Permit/Registration Holder Permit Exp. Date Time In Time Out Inspection Type Marisa Correa-Amaya i0,30 tr3'5 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 E]] El 22 Parts replaced between clients - grommets, elastic bands, ❑ test etc. ❑ Body Art Inspecto Report Date: 11517,0 1S ❑ 10. Hands washed effectively and timely ❑ San Joaquin County Environmental Health Department Program ❑ ❑ 1868 E. Hazelton Ave., Stockton, CA 95205 Record: ❑ cl p. (209) 468-3420 Program El ❑ www.slogv.org/ehd Element: ❑ Facility Name Address City Zip Code Port City Ink 1415 rosemarie In # b Stockton 95207 Name of Permit/Registration Holder Permit Exp. Date Time In Time Out Inspection Type Marisa Correa-Amaya i0,30 tr3'5 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 E]] El 22 Parts replaced between clients - grommets, elastic bands, ❑ test etc. ❑ 2' Items washed, disinfected, packaged, labeled, and Elsterilized ❑ 10. Hands washed effectively and timely ❑ 3. Autoclave loaded correctly/packages allowed to dry ❑ ❑ 4. Integrators used/monthly spore test/log maintained ❑ ❑ 5. Decontamination/sanitation area separated and supplied El ❑ 29. appropriately ❑ ® 6 Invoices and log kept for disposable, pre -sterilized ❑ equipment ❑ 7 Sharps containers labeled, used, and disposed of ❑ riatel appropriately ❑ 8 Jewelry, tattoo and piercing equipment - clean and ❑ PRACTITIONER HEALTH AND HYGIENE ❑ 9. No eating, drinking or smoking - clean clothes ❑ ❑ 10. Hands washed effectively and timely ❑ ❑ 11 Handwashing facilities properly supplied and accessible, warm water ❑ ❑ 12. Hepatitis B vaccination ❑ ❑ 13. Bloodborne Pathogen training El ❑ 29. Source: Above Training ❑ ❑ 14. Appropriate personal protective equipment available and ❑ ❑ 15. Branding is completed with no other customers in area Elrocedure ❑ 16. Customers eighteen (18) years of age or older ❑ ❑ 17. Skin adequately prepared for procedure ❑ ® 18' Client records approved and available - Consent form and questionnaire ❑ ® 19. Appropriate aftercare instructions given to client ❑ MACHINE SAFETY AND SANITATION ❑ 20. Safe machine design ❑ ❑ 21. Machines cleaned and disinfected between clients ❑ Received Mattu Received PREVENTING CROSS -CONTAMINATION ❑ 23. Workstation/procedure area decontaminated ❑ ❑ 24. Appropriate chemical disinfectant used El Chemical used: Madacide ❑ 25. Disinfectant used appropriately/sufficient contact time ❑ ❑ 32. Wet contact time provided: 3 mins ❑ ❑ 26. Barriers used ❑ [j 27. Products applied to skin are single use/dispensed ase tical) ❑ ❑ 28. Storage of inks, pigments, needles, tubes, etc. ❑ ❑ 29. Jewelry, Inks, Needles etc approved and used correctly ❑ ❑ 30. Cross -contamination avoided during all phases of ❑ BEST BUSINESS PRACTICES ❑ 31. Areas separated/no living or sleeping quarters ❑ ❑ 32. Floors and walls clean and in good repair, adequate light ❑ El 33. Workstation, surfaces, including chairs, armrests, etc. in repair Elood ® 34. Permit/registration posted ❑ ® 35. Operation and employee training records present ❑ COMPLIANCE AND ENFORCEMENT ❑ 36. Plan(s) submitted for review ❑ ® 37. Permits obtained and available ❑ ❑ 38. Impoundment ❑ ❑ 39. Hearing scheduled ❑ ❑ 40. Closure ❑ ❑ 41 A❑ iature):\ U�'hone: Z� 1 LQ 1. lDL1G Reinspecion on/about: A reinspection fee of $125 per hour may charged. Page 1 of 2 EH -04/2014