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u a� Body Art Inspection Report Date: July 16,2024 San Joaquin County Environmental Health Department Program 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: AP2400709 (209)468-3420 •moo - w .sioay.om/ehd Program \iF o6? Element: 4103 Facility Name Address City Zip Code Elusive Permanent Makeup&Tattoo 3200 Naglee Rd#116 Tracy 95304 Name of Permit/Registration Holder Permit Exp.Date Time In Time Out Inspection Type Alekxis Mondragon Consultation The facility 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 I MACHINE SAFETY AND SANITATION cont C HSC 119315-Autoclave:approved and effective-passed HSC 119311 -Parts replaced between clients-grommets, ❑ 1' integrator test 11 E] 22. elastic bands,etc. ❑ ❑ HSC 119309-Items washed,disinfected,packaged,2' labeled,and sterilized 1-1PREVENTING CROSS-CONTAMINATION ❑ 3 HSC 119315-Autoclave loaded correctly/packages ❑ ❑ 23. HSC 119309-Workstation/procedure area decontaminated ❑ allowed to dry I ❑ 4 HSC 119315-Integrators used/monthly spore test/log ❑ 24. HSC 119301 -Appropriate chemical disinfectant used maintained ❑ ❑ HSC 119314-DecontaminatioNsanitation area separated ❑ 5' and su lied a ro riatel ❑ Chemical used: Cavacitle ® 8 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' disposed of appropriately ❑ Wet contact time provided: 10 mins HSC 119310, 119315-Jewelry,tattoo and piercing ❑ 8. a ui ment-clean and sterilized El El 26. HSC 119314-Barriers used 1-1 ❑ 27 HSC 119311 -Products applied to skin are single El PRACTITIONER HEALTH AND HYGIENE use/dispensed aseptically ❑ 9 HSC 119309-No eating,drinking or smoking-clean ® ❑ 26 HSC 119309, 119311 -Storage of inks,pigments,needles, ❑ clothes tubes,etc. ❑ 10. HSC 119308-Hands washed effectively and timely El El 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' Eland accessible,warm water ❑ 30' phases of procedure El ❑ 12. HSC 119306-Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES 13. HSC 119307-Bloodbome 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 ❑ HSC 119308-Appropriate personal protective equipment HSC 119314-Workstation,surfaces,including chairs, ❑ 14. available and used [I El 33' armrests,etc.in good repair CUSTOMERS/CLIENTS ❑ 34. HSC 119312-Permit/registration posted ❑ HSC 119309-Branding is completed with no other HSC 119313-Operation and employee training records ❑ 15. E] 35'customers in procedure area ❑ resent E] HSC 119302-Customers eighteen(18)years of age or El 16. older El AND ENFORCEMENT ❑ 17. HSC 119308-Skin adequately prepared for procedure ❑ ❑ 36. HSC 119312-Plants)submitted for review ❑ ® HSC 119303-Client records approved and available- 18. questionnaire ❑ El 37. HSC 119312-Permits obtained and available Consent form and ® HSC 119303, 119308-Appropriate aftercare instructions 19. EI El 38. HSC 119319-Impoundment given to client 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): Alekxis Mondragon Received by(Signature): EMAILED Phone:831-406-0418 Specialist(Print): Sandip Singh Specialist(Signature):Sa&&4&-Yee � Phone:209-488-3526 T Reinspection on/about: A reinspection fee of$172 per hour may be charged. Page 1 of 4 EH-11/17