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�. Body Art Inspection Report Date: January9,2025 a < San Joaquin County Environmental Health Department Program 1868 E.Hezelton Ave.,Stockton,CA 95205 Record: New PR# (209)468-3420 www.s oayom/eha Program �cicoP 1� Element: 4120 Facility Name Address City Zip Code Studio 111 1005 Pescadero Ave#155 Tracy 95304 Name of Permit/Registration Holder Permit Exp.Date Time In Time Out Inspection Type Fabian Chaves 6/30125 Final 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 1=,-etc Parts replaced between clients-grommets, ❑ 1' integrator test ❑ ❑ 22. elastic . ❑ HSC 119309-Items washed,disinfected,packaged.El 2' labeled,and sterilized El CROSS-CONTAMINATION ❑ 3 HSC 119315-Autoclave loaded correctly/packages ❑ ❑ 23. HSC 119309-Workstation/procedure area decontaminated ❑ allowed to dry ❑ 4 HSC 119315-Integrators used/monthly spore testllog maintained ❑ 24. HSC 119301 -Appropriate chemical disinfectant used El 5' HSC 119314-DecontaminatioNsanitation area separated Eland supplied appropriately ❑ Chemical used: El ❑ HSC 119315-Invoices and log kept for disposable,pre- HSC 119309-Disinfectant used appropriately/sufficient 6' I sterilized equipment ❑ ❑ 25' contact time ❑ HSC 119314-Sharps containers labeled,used,and El7. disposed of appropriately ❑ Wet contact time provided: HSC 119310. 119315-Jewelry,tattoo and piercing El 8. equipment-clean and sterilized El El26. HSC 119314-Barriers used El HSC 119311 -Products applied to skin are single PRACTITIONER HEALTH AND HYGIENE ❑ 27 use/dispensed 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 El El29_ HSC 119310, 119311 -Jewelry, Inks,Needles etc approved ❑ and used correctly ❑ 11. HSC 119314-Handwashing facilities properly supplied HSC 119308-Cross-contamination avoided during all and accessible,warm water El ❑ 30' hases of rocedure 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 li ht ❑ HSC 119308-Appropriate personal protective equipment HSC 119314-Workstation,surfaces,including chairs, ❑ 14. available and used ❑ ❑ 33. armrests,etc.in ood re air ❑ CUSTOMERS/CLIENTS ❑ 34. HSC 119312-Permit/registration posted ❑ HSC 119309-Branding is completed with no other HSC 119313-Operation and employee training records ❑ 15. customers in procedure area ❑ ❑ 35' resent ❑ ❑ HSC 119302-Customers eighteen(18)years of age or 18. older ❑ COMPLIANCE AND ENFORCEMENT ❑ 17. HSC 119308-Skin adequately prepared for procedure ❑ ❑ 36. HSC 119312-Plants)submitted for review ❑ ❑ 18 HSC 119303-Client records approved and available-Consent form and questionnaire El El37. HSC 119312-Permits obtained and available El HSC 119303, 119308-Appropriate aftercare instructions ❑ 19. ❑ ❑ 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): Fabian Chaves Received by(Signature): EMAILED Phone:415-933-7138 Specialist(Print)' Sandip Singh Specialist(Signature): LW&49-a-,# Phone'209-468-3526 Reinspection onlabout: A reinspection fee of$172 per hour may be charged. Page 1 of 2 EH-11/17