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o;r <br /> Body Art InspAo Report itDate:San Joaquin County Environmental Health Department Program �l1868 E.Hazelton Ave_,Stockton,CA 95205 <br /> Record:(209)468-3420 Program nusI.. www siogv org/ehd Element: T( ORa. <br /> Facility Name <br /> Address City Zip Code <br /> 12 Monkeys Tattoo Studio 911 central ave. <br /> Tracy 95376 <br /> Name of Permit/Registration Holder <br /> Permit Exp.Date Time In Time Out Inspection Type <br /> Routine <br /> Jon Highland 6/30/17 <br /> The above facility is inspected for compliance with Division 104, <br /> P C 1 Corrected On SCelifomia Health and Safety Code(HSC). <br /> C v MACHINE SAFETY AND SANITATION cont.) C <br /> V CLEANING AND STERILIZATION Parts replaced between clients-grommets,elastic bands, ❑ <br /> ❑ Autoclave:approved and effective-passed integrator ❑ ❑ 22. etc. <br /> 1' test <br /> ❑ Items washed,disinfected,packaged,labeled,and ❑ PREVENTING CROSS-CONTAMINATION <br /> 2' sterilized <br /> ❑ 23. Workstation/procedure area decontaminated ❑ <br /> 3. Autoclave loaded correctly/packages allowed to dry ❑ ❑ <br /> ❑ 4. Integrators used/monthly spore test/log maintained ❑ ❑ <br /> 24. Appropriate chemical disinfectant used ❑ <br /> Decontamination/sanitation area separated and supplied ❑ Chemical used: <br /> ❑ 5' <br /> appropriately <br /> Invoices and log kept for disposable,pre-sterilized ❑ ❑ 25. Disinfectant used appropriately/sufficient contact time ❑ <br /> ® 6' <br /> equipment <br /> ❑ Sharps containers labeled,used,and disposed of ❑ Wet contact time provided: <br /> 7' <br /> appropriately <br /> Jewelry,tattoo and piercing equipment-clean and ❑ ❑ 26. Barriers used ❑ <br /> ❑ 8' sterilized <br /> ❑ 27 Products applied to skin are single use/dispensed ❑ <br /> PRACTITIONER HEALTH AND HYGIENE aseptically <br /> ❑ 9. No eating,drinking or smoking-clean clothes ❑ ❑ 28. Storage of inks,pigments,needles,tubes,etc. ❑ <br /> ❑ 10. Hands washed effectively and timely ❑ PErocledure Inks,Needles etc approved and used correctly ❑ <br /> Handwashing facilities properly supplied and accessible, ❑ ontamination avoided d�urinngl phases of ❑ <br /> ❑ 11. warm water <br /> ❑ 12. Hepatitis B vaccination ❑ USINESS PRACTICES <br /> ❑ 13. Bloodbome Pathogen training ® 31. Areas separated/no living or sleeping quarters El <br /> Source: ❑ ❑ 32. Floors and walls clean and in good repair,adequate light ❑ <br /> El [1 Workstation,surfaces,including chairs,armrests,etc.in <br /> Appropriate personal protective equipment available and ❑ <br /> LO14. used good repair <br /> ❑ 34. Permit/registration posted ❑ <br /> CUSTOMERSICLIENTS <br /> ❑ 15. Branding is completed with no other customers in ❑ ® 35. Operation and employee training records present ❑ <br /> procedure area <br /> ❑ 16. Customers eighteen(18)years of age or older ❑ COMPLIANCE AND ENFORCEMENT <br /> ❑ 17. Skin adequately prepared for procedure E] ❑ 36. Plan(s)submitted for review El <br /> El 18 Client records approved and available-Consent form ❑ ❑ 37. Permits obtained and available ❑ <br /> and uestionnaire <br /> ❑ 19. Appropriate aftercare instructions given to client ❑ El38. Impoundment ❑ <br /> ❑ 39. Hearing scheduled ❑ <br /> MACHINE SAFETY AND SANITATION <br /> ❑ 20. Safe machine design ❑ ❑ 40. Closure ❑ <br /> 01 21. Machines cleaned and disinfected between clients ❑ ❑ <br /> Received b (Print): Jon Hi hland Received b Si : 209 839-1265 <br /> Specialist(Print): Benjamin Escotto,Sr REHS Specialist(Signature): Phone: 209 468-3178 <br /> Reinspecion onlabout: A reinspection fee of$130 per hour may be charged. Page 1 of 2 <br /> EH-03/2015 <br />