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u Body Art Inspection Report Date: June 19,2024 ti.4 San Joaquin County Environmental Health Department Program 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: SR0087836 ' ;209)468-3420 `O `P www.siogv.orq/ehd Program Element: 4103 Facility Name Address City Zip Code Final Dest nation 9210 Thornton Rd#5 Stockton 95209 Name of Permit/Registration Holder Permit Exp.Date Time In Time Out Inspection Type Kristalyn J menez Consultation The facil t is inspected for compliance with Division 104, Part 15,Cha ter 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 HSC 119315-Autoclave:approved and effective-passed HSC 119311 -Parts replaced between clients-grommets, ❑ integrator test ❑ ❑ 22' elastic bands,etc. ❑ 2 HSC 119309-Items washed,disinfected,packaged, labeled,and sterilized El CROSS-CONTAM[NATION ❑ 3 HSC 119315-.Autoclave loaded correctly/packages allowed to d ❑ ❑ 23. HSC 119309-Workstation/procedure area decontaminated ❑ ❑ 4 HSC 11931 E-Integrators used/monthly spore test/log maintained El 24. HSC 119301 -Appropriate chemical disinfectant used El ❑ ❑ 5 HSC 119314-decontamination/sanitation area separated and supplied appropriately El Chemical used: ® 6 HSC 119315-Invoices and log kept for disposable,pre- HSC 119309-Disinfectant used appropriately/sufficient sterilized aqui anent ❑ ❑ 25" contact time Eldis disposed of aro riatel ® 7 HSC 119314-Sharps containers labeled,used,and ❑ Wet contact time provided: ❑ $ HSC 119310, 119315-Jewelry,tattoo and piercing equipment- -lean and sterilized El El26. HSC 119314-Barriers used El ❑ 27 HSC 119311 -Products applied to skin are single ❑ PRACTITIONER HEALTH AND HYGIENE use/dispensed aseptically ❑ 9 HSC 119309-No eating,drinking or smoking-clean ❑ ❑ 28 HSC 119309, 119311 -Storage of inks,pigments,needles, E]clothes tubes,etc. ❑ 10. HSC 119308-Hands washed effectively and timely ❑ ❑ 29 HSC 119310, 119311 -Jewelry, Inks,Needles etc approved ❑ and used correct) HSC 119314-Handwashing facilities properly supplied HSC 119308-Cross-contamination avoided during all ❑ 11. and accessible,warm water ❑ ❑ 30" phases of procedure ❑ ❑ 12. HSC 119306-Hepatitis B vaccination ❑ I BEST BUSINESS PRACTICES 13. HSC 119307-Bloodborne Pathogen training ❑ 31. HSC 119314-Areas separated/no living or sleeping quarters ❑ ® Source: El HSC 32 HSC 119314-Floors and walls clean and in good repair, Eladequate light HSC 119308-Appropriate personal protective equipment HSC 119314-Workstation,surfaces,including chairs, El 14. available and used El ® 33' armrests,etc.in good repair r_1 CUSTOMERS/CLIENTS ❑ 34. HSC 119312-Permit/registration posted ❑ HSC 119309-Branding is completed with no other HSC 119313-Operation and employee training records El 15. customers in procedure area El ® 35. resent El ❑ 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. questionnaire E] E:137. HSC 119312 Permits obtained and available ElConsent form and HSC 119303, 119308-Appropriate aftercare instructions ® 19. HSC to clien ❑ ❑ 38. HSC 119319-Impoundment El MACKNE SAFETY AND SANITATION ❑ 39. HSC 119320-Hearing scheduled ❑ ❑ 20. iSC 119311 -Safe machine design ❑ ❑ 40. HSC 119312, 119317, 119320-Closure ❑ ❑ 21 iSC 119311 -Machines cleaned and disinfected between ❑ rEIT41T ❑ clients Received bw(Print): Kristalyn Jimenez Received by(Signature): EMAILED Phone:209-981-2325 Specialist(Print): Sandip Singh Specialist(Signature): Saca�o� Phone:209-468-3526 Reinspection on/about: A reinspection fee of$162 per hour may be charged. Page 1 of 3 EH-11/17