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oG Body Art Inspection Report Date: March 27,2025 NSan Joaquin County Environmental Health Department Program 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: PR0545320 (209)468-3420 • CC 1T www.siogv.org/ehd Program �Ci aCt� Element: 4120 Facility Name Address City Zip Code Brows by Michelle Grace 37 W.Yokuts Ave Stockton CA, 95207 Name of Permit/Registration Holder Permit Exp. Date Time In Time Out Inspection Type Michelle Tabancura Routine The 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 HSC 119315-Autoclave:approved and effective-passed HSC 119311 -Parts replaced between clients-grommets, ❑ 1 integrator test ❑ El 22 elastic bands,etc. El 119309-Items washed,disinfected,packaged, ❑ 2. labeled,and sterilized ❑ PREVENTING CROSS-CONTAMINATION ❑ HSC 119315-Autoclave loaded correctly/packages 3' allowed to d El ❑ 23. HSC 119309 Workstation/procedure area decontaminated ❑ ❑ HSC 119315-Integrators used/monthly spore test/log 4' El24. HSC 119301 -Appropriate chemical disinfectant used maintained El ElHSC 119314-Decontamination/sanitation area separated ❑ 5' and supplied appropriately El Chemical used: CaviWipes ❑ 6 HSC 119315-Invoices and log kept for disposable,pre- ❑ 25 HSC 119309-Disinfectant used appropriately/sufficient sterilized equipment ❑ contact time ❑ ❑ HSC 119314-Sharps containers labeled, used,and 7' El Wet contact time provided: 3 minutes disposed of appropriately ❑ 8 HSC 119310, 119315-Jewelry,tattoo and piercing ❑ ❑ 26. HSC 119314-Barriers used ❑ equipment-clean and sterilized HSC 119311 -Products applied to skin are single PRACTITIONER HEALTH AND HYGIENE El 27' use/dispensed asepticallyEl ❑ 9 HSC 119309-No eating,drinking or smoking-clean ® ❑ 28 HSC 119309, 119311 -Storage of inks,pigments,needles, Elclothes tubes,etc. ❑ HSC 119310, 119311 -Jewelry, Inks, Needles etc approved 10. HSC 119308-Hands washed effectively and timely El El29 and used correctlyEl HSC 119314-Handwashing facilities properly supplied HSC 119308-Cross-contamination avoided during all El 11. and accessible,warm water El ❑ 30' phases of procedure ❑ IM ❑ 12. HSC 119306-Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES 13. HSC 119307-Bloodborne Pathogen training ❑ 31. HSC 119314-Areas separated/no living or sleeping quarters ❑ ❑ Source: Biologix Solutions(Exp.2/28/26) ❑ El 32 HSC 119314-Floors and walls clean and in good repair, ❑ adequate light HSC 119308-Appropriate personal protective equipment HSC 119314-Workstation,surfaces,including chairs, ❑ 14. available and used ❑ ® 33. armrests,etc.in good repair ❑ CUSTOMERS/CLIENTS ❑ 34. HSC 119312-Perm it/registration posted ❑ HSC 119309-Branding is completed with no other HSC 119313-Operation and employee training records ❑ 15. customers in procedure area ❑ ® 35. present ❑ ❑ 16. HSC 119302-Customers eighteen(18)years of age or ❑ older COMPLIANCE AND ENFORCEMENT ❑ 17. HSC 119308-Skin adequately prepared for procedure ❑ ❑ 36. HSC 119312-Plan(s)submitted for review ❑ ® HSC 119303-Client records approved and available- ❑18. ❑ ❑ 37. HSC 119312-Permits obtained and available Consent form and questionnaire HSC 119303, 119308-Appropriate aftercare instructions 19. ❑ ❑ 38. HSC 119319-Impoundment Eliven to client MACHINE SAFETY AND SANITATION ❑ 39. HSC 119320-Hearing scheduled El ❑ 20. HSC 119311 -Safe machine design ❑ ❑ 40. HSC 119312, 119317, 119320-Closure ❑ ❑ 21 HSC 119311 -Machines cleaned and disinfected between ❑ ❑ 41. ❑ clients Received by(Print): Michelle Tabancura Received by(Signature): EMAILED Phone: Specialist(Print): Alexander Cruz Specialist(Signature): Phone:209-616-3042 Reinspection on/about: A reinspection fee of$172 per hour may be charged. Page 1 of 3 EH-12-4-23