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i --bUIN Body Art Inspection Report Date: May 12, 2025 San Joaquin Count Environmental Health Department q Y p Program '~ 1868 E. Hazelton Ave., Stockton, CA 95205 Record: PR0548626 (209)468-3420 Program \\Cq �P www.siogv.oro/ehd �T-*___' Element: 4120 Facility Name Address City Zip Code Adorn Me Tattoo 5759 Pacific Ave 4B145 Stockton 95207 Name of Permit/Registration Holder Permit Exp. Date Time In Time Out Inspection Type Jennifer Bou 6/30/25 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 ❑ 1 HSC 119315 -Autoclave: approved and effective - passed HSC 119311 - Parts replaced between clients - grommets, inte rator test [I ❑ 22' elastic bands, etc. ❑ HSC 119309 - Items washed, disinfected, packaged, El 2' labeled, and sterilized El CROSS-CONTAMINATION ❑ HSC 119315 - Autoclave loaded correctly/packages 3' allowed to d ElEl23. HSC 119309 - Workstation/procedure area decontaminated El ❑ 4 HSC 119315 - Integrators used/monthly spore test/log ❑ 24. HSC 119301 - Appropriate chemical disinfectant used maintained ❑ ❑ ❑ 5 HSC 119314 - Decontamination/sanitation area separated appropriately ❑ Chemical used: Caviwipe and supplied ❑ 6 HSC 119315 - Invoices and log kept for disposable, pre- El HSC 119309 - Disinfectant used appropriately/sufficient sterilized equipment ❑ 25' contact time Eldis disposed of appropriately- El7 HSC 119314 - Sharps containers labeled, used, and ❑ Wet contact time provided: 1 min. HSC 119310, 119315 Jewelry, tattoo and piercing El8' equipment - clean and sterilized ElEl26. HSC 119314 - Barriers used El HSC 119311 - Products applied to skin are single PRACTITIONER HEALTH AND HYGIENE El 27' use/dispensed aseptically El ❑ 9 HSC 119309 - No eating, drinking or smoking - clean HSC 119309, 119311 - Storage of inks, pigments, needles, clothes El ❑ 28' Eltubes, etc. ❑ 10. HSC 119308 - Hands washed effectively and timely ❑ ❑ 29 HSC 119310, 119311 - Jewelry, Inks, Needles etc approved ❑ and used correct) ❑ 11. HSC 119314 - Handwashing facilities properly supplied and HSC 119308 - Cross-contamination avoided during all accessible, warm water El ❑ 30' El of procedure ❑ 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 ❑ ❑ ❑ HSC 119314 - Floors and walls clean and in good repair, Source: 32. adequate light ❑ ❑ 14. HSC 119308 - Appropriate personal protective equipment ❑ HSC 119314 - Workstation, surfaces, including chairs, available and used ❑ ® 33. armrests, etc. in good repair CUSTOMERS/CLIENTS ❑ 34. HSC 119312 - Permit/registration posted ❑ ❑ 15. HSC 119309 - Branding is completed with no other HSC 119313 - Operation and employee training records customers in procedure area El El 35' present ❑ ❑ 16. HSC 119302 - Customers eighteen (18) years of age or older El 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' Consent form and questionnaire ❑ ❑ 37. HSC 119312 - Permits obtained and available HSC 119303, 119308 - Appropriate aftercare instructions El 19. iven to client El El38. HSC 119319 - Impoundment El MACHINE SAFETY AND SANITATION ❑ 39. HSC 119320 - Hearing scheduled ❑ ❑ 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): Jennifer Bou Received by (Signature): EMAILED Phone: 209-326-3940 Specialist (Print): Sandip Singh Specialist (Signature): Phone: 209-468-3526 Reinspection on/about: A reinspection fee of$172 per hour may be charged. Page 1 of 2 EH-11/17