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n a Body Art Inspection Report Date: January 2,2025 San Joaquin County Environmental Health Department Program 9 ' 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: AP2401423 ziiiit ' (209)468-3420 -' � www sioov.orclehd Program Element: 4103 0 Facility Name Address City Zip Code Studio 111 1005 Pescadero Ave. Studio 111 Tracy 95304 Name of Permit/Registration Holder Permit Exp. Date Time In Time Out Inspection Type Fabian Chaves 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 MACHINE SAFETY AND SANITATION cont. C HSC 119315-Autoclave: approved and effective-passed HSC 119311 -Parts replaced between clients-grommets, ❑ 1 integrator test ❑ ❑ 22. elastic bands, etc. El HSC 119309-Items washed,disinfected,packaged, El 2' labeled,and sterilized ❑ PREVENTING CROSS-CONTAMINATION HSC 119315-Autoclave loaded correctly/packages ❑ 3' allowed to d ❑ El23. HSC 119309-Workstation/procedure area decontaminated ❑ ❑ HSC 119315-Integrators used/monthly spore testflog 4' ❑ 24. HSC 119301 -Appropriate chemical disinfectant used maintained ❑ ❑ HSC 119314-Decontamination/sanitation area separated ❑ 5' and supplied appropriately ❑ Chemical used: ❑ 6 HSC 119315-Invoices and log kept for disposable,pre- El HSC 119309-Disinfectant used appropriately/sufficient sterilized equipment ❑ contact time ❑ ❑ 7 HSC 119314-Sharps containers labeled,used,and ❑ Wet contact time provided: disposed of appropriately ® 8 HSC 119310, 119315-Jewelry,tattoo and piercing ElEl26, HSC 119314-Barriers used ❑ equipment-clean and sterilized HSC 119311 -Products applied to skin are single PRACTITIONER HEALTH AND HYGIENE ❑ 27 useldis ensed aseptically ❑ ❑ 9 HSC 119309-No eating,drinking or smoking-clean ❑ ❑ 28 HSC 119309, 119311 -Storage of inks,pigments, needles, ❑ clothes tubes,etc. ❑ 10. HSC 119308-Hands washed effectively and timely ❑ ❑ 29 HSC 119310. 119311 -Jewelry, Inks, Needles etc approved ❑ and used correct) El HSC 119314-Handwashing facilities property supplied HSC 119308-Cross-contamination avoided during all 11. and accessible,warts water ❑ ❑ 30' phases 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 ❑ Source: ❑ 32 HSC 119314-Floors and walls clean and in good repair, ❑ 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 ❑ ❑ 35' resent ❑ 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 ❑ ❑ 18 HSC 119303-Client records approved and available- Consent form and uestionnaire ❑ ❑ 37. HSC 119312-Permits obtained and available El ❑ t9 HSC 119303, 119308-Appropriate aftercare instructions ❑ ❑ 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 HSC 119309 The practitioner shall maintain a clean ❑ clients and sanitary environment. Received b (Print): Fabian Chaves Received b Si nature : E AILED Phone:415-933-7138 Specialist(Print): Stephanie Ramirez Specialist(Signature): / Phone:209-616-3069 Reinspectlon on/about: A reinspection fee of$172 per hour may be charged. Page 1 of 2 EH-11117