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Sod Art Ins ecti&e ort <br /> °'"..,`.....�o Y P P Date: 11 L <br /> San Joaquin County Environmental Health Department Program ^ <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: <br /> \c P (209)468-3420 Program <br /> q�iFo'ea` www.sjogv.org/ehd Element: <br /> Facility Name Address City Zip Code <br /> 12 monkeys Tattoo Studio 911 central ave. Tracy 95376 <br /> Name of Permit/Registration Holder Permit Exp. Date Time In Time Out Inspection Type <br /> Jon E.Highland 6/30/19 Routine <br /> The above facility is inspected for compliance with Division 104,Part 15,Chapter 7 of California Health and Safety Code(HSC). <br /> V=Violation C=Corrected On Site <br /> V CLEANING AND STERILIZATION C V MACHINE SAFETY AND SANITATION(cant.) C <br /> ❑ 1 Autoclave:approved and effective-passed integrator ❑ [1 22 Parts replaced between clients-grommets,elastic bands, E]test etc. <br /> Items washed,disinfected,packaged,labeled,and <br /> ❑ 2" sterilized El CROSS-CONTAMINATION <br /> ❑ 3. Autoclave loaded correctly/packages allowed to dry ❑ ❑ 23. Workstation/procedure area decontaminated ❑ <br /> ❑ 4. Integrators used/monthly spore test/log maintained ❑ ❑ 24. Appropriate chemical disinfectant used <br /> Decontamination/sanitation area separated and supplied Chemical used: ❑ <br /> ❑ 5. appropriately ❑ <br /> Invoices and log kept for disposable,pre-sterilized <br /> ❑ 6' ❑ ® 25. Disinfectant used appropriately/sufficient contact time <br /> equipment <br /> ❑ 7 Sharps containers labeled,used,and disposed of ❑ Wet contact time provided: ❑ <br /> appropriately <br /> ❑ 8 Jewelry,tattoo and piercing equipment-clean and ❑ ❑ 26. Barriers used ❑ <br /> sterilized <br /> Products applied to skin are single use/dispensed <br /> PRACTITIONER HEALTH AND HYGIENE ❑ 27. aseptically ❑ <br /> ® 9. No eating,drinking or smoking-clean clothes ❑ ❑ 28. Storage of inks,pigments,needles,tubes,etc. ❑ <br /> El10. Hands washed effectively and timely El F-1 29. Jewelry, Inks,Needles etc approved and used correctly E]Handwashing facilities properly supplied and accessible, Cross-contamination avoided during all phases of <br /> ❑ 11. warns water ❑ ❑ 1 30' 1 procedure ❑ <br /> ❑ 12. Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES <br /> ❑ 13. Bloodbome Pathogen training ❑ rEE1 31. Areas separated/no living or sleeping quarters El <br /> Source: 32. Floors and walls clean and in good repair,adequate light ❑ <br /> ❑ 14. Appropriate personal protective equipment available and ❑ 33 Workstation,surfaces,including chairs,armrests,etc.inElused ood re air <br /> CUSTOMERS/CLIENT$ 34. Permittregistration posted El <br /> Branding is completed with no other customers in <br /> ❑ 15. El El 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 ❑ ❑ 36. Plan(s)submitted for review ❑ <br /> Client records approved and available-Consent form <br /> ® 18. ❑ ❑ 37. Permits obtained and available El <br /> duestionnaire <br /> ❑ 19. Appropriate aftercare instructions given to client ❑ ❑ 38. Impoundment ❑ <br /> MACHINE SAFETY AND SANITATION ❑ 39. Hearing scheduled ❑ <br /> ❑ 20. Safe machine design ❑ ❑ 40. Closure ❑ <br /> ❑ 21. Machines cleaned and disinfected between clients ❑ ❑ 41. ❑ <br /> Received b (Print): Jon E. Highland Received b ( Phone:-2098391265 <br /> LS <br /> Specialist(Print): Jesse Easter Specialist(Si Ph 2099537310 <br /> Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Page 1 of 2 <br /> EH-11/17 <br />