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u <br /> ° Body Art Inspection Report <br /> Date: July 24,2024 <br /> i San Joaquin County Environmental Health Department Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: 4120 <br /> (209)468-3420 <br /> v .sioay.oro/ehd Program <br /> rr;o Element: New PR# <br /> Facility Name Address city Zip Code <br /> Elusive 3200 Naglee Rd. Tracy 95304 <br /> Name of Permit/Registration Holder Permit Exp.Date Time In Time Out Inspection Type <br /> Alekxis Mondragon 6/30/25 Routine <br /> 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 <br /> V CLEANING AND STERILIZATION C. V I MACHINE SAFETY AND SANITATION cont C <br /> HSC 119315-Autoclave:approved and effective-passed HSC 119311 -Parts replaced between clients-grommets, <br /> ❑ 1' integrator test [I ❑ 22. elastic bands,etc. ❑ <br /> ❑ <br /> HSC 119309-Items washed,disinfected,packaged,2' labeled,and sterilized ❑ PREVENTING CROSS-CONTAMINATION <br /> ❑ 3 HSC 119315-Autoclave loaded correctly/packages ❑ ❑ 23. HSC 119309-Workstation/procedure area decontaminated ❑ <br /> allowed to d <br /> ❑ 4 HSC 119315-Integrators used/monthly spore test/log ❑ 24. HSC 119301 -Appropriate chemical disinfectant used <br /> maintained El ❑ <br /> HSC 119314-Decontaminationtsanitation area separated <br /> ❑ 5' Chemical used: <br /> and supplied appropriately <br /> ❑ <br /> ❑ 6 HSC 119315-Invoices and log kept for disposable,pre- ❑ 25 HSC 119309-Disinfectant used appropriately/sufficient <br /> sterilized equipment ❑ contact time ❑ <br /> HSC 119314-Sharps containers labeled,used,and <br /> ❑ 7' dis osed of a ro riatel ❑ Wet contact time provided: <br /> HSC 119310, 119315-Jewelry,tattoo and piercing <br /> El 8. 26. HSC 119314-Barriers used <br /> equipment-clean and sterilized ❑ ❑ ❑ <br /> HSC 119311 -Products applied to skin are single <br /> PRACTITIONER HEALTH AND HYGIENE 127 use/dispensed aseptically ❑ <br /> ❑ 9 HSC 119309-No eating,drinking or smoking-clean ❑ HSC 119309, 119311 -Storage of inks,pigments,needles, ❑ <br /> clothes tubes,etc. <br /> ❑ 10. HSC 119308-Hands washed effectively and timely ❑ HSC 119310, 119311 -Jewelry,Inks, Needles etc approved ❑ <br /> and used correct) <br /> HSC 119314-Handwashing facilities properly supplied HSC 119308-Cross-contamination avoided during all <br /> ❑ 11. and accessible,warm water ❑ hases of rocedure12. HSC 119306-Hepatitis B vaccination ❑ BUSINESS PRACTICES <br /> 13. HSC 119307-Bloodbome Pathogen training HSC 119314-Areas separated/no living or sleeping quarters ❑❑ Source: ❑ HSC 119314-Floors and walls clean and in good repair,ade uate li MHSC 119308-Appropriate personal protective equipmentHSC 119314-Workstation,surfaces,including chairs,❑ 14. available and used ❑ armrests,etc.in ood re air ❑CUSTOMERSICLIENTS HSC 119312-Permit/registration posted ❑ <br /> HSC 119309-Branding is completed with no other HSC 119313-Operation and employee training records <br /> ❑ 15. customers in procedure area ❑ ❑ 35' resent ❑ <br /> HSC 119302-Customers eighteen(18)years of age or <br /> ❑ 16. older Ell COMPLIANCE AND ENFORCEMENT <br /> ❑ 17. HSC 119308-Skin adequately prepared for procedure ❑ ❑ $38. HSC <br /> C 119312-Plan(s)submitted for review ❑ <br /> HSC 119303-Client records approved and available- 37.18. Consent form and questionnaire ❑ ❑ C 119312-Permits obtained and available ❑ <br /> HSC 119303, 119308-Appropriate aftercare instructions <br /> ❑ 19' given to client ❑ ❑ 119319-Impoundment ❑MACHINE SAFETY AND SANITATION C 119320-Hearing scheduled ❑❑ 20. HSC 119311 -Safe machine design ❑ ❑ C 119312, 119317, 119320-Closure ❑ <br /> ❑ 21 HSC 119311 -Machines cleaned and disinfected betweenEl ❑ 41. Elclients <br /> Received by(Print): Alekxis Mondragon Received by(Signature): EMAILED Phone:831-406-0418 <br /> Specialist(Print): Sandip Singh Specialist(Signature): Sc,�'* Phone:209-468-3526 <br /> Reinspection on/about: A reinspection fee of$172 per hour may be charged. Page 1 of 2 <br /> EH-11/17 <br />