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Body Art Inspection Report Date (MM/DDNY) <br />County of San Joaquin County, Environmental Health Department <br />H1868 E. Hazelton Ave., Stockton CA 95205 Permit Number <br />(209) 468-3420 www.sigov.org/ehd <br />Permit Type <br />Facility Name Address City Zip Code CT <br />Perm&egistration Holder Name Permit Exp. Date Total Time Inspection Type <br />J" <br />�Ca✓1/� P-1-r'A 02_ mslfit"CiT7C'i�\ <br />RISK FACTORS AND INTERVENTIONS <br />Risk factors are improper practices or procedures identified <br />as contributing factors of cross -contamination. <br />Interventions are control measures to prevent cross -contamination <br />and transfer of pathogens from one person to another. <br />In = In Compliance Out = Not in Compliance N/O = Not <br />Observed <br />N/A = Not Applicable COS = Corrected On Site <br />4 <br />CLEANING AND STERILIZATION our cos <br />OSM <br />TATTOOANCiPERMANENT C ETICS MACHINE <br />SAFETY. AND SANITATION ., our cos <br />In N/0 <br />N/A <br />1. Autoclave is approved and effective - passed <br />integrator test <br />El. <br />IjN/A <br />Safe machine design <br />18[I <br />El <br />0 <br />In 10 <br />N/ <br />2. Process of cleaning, labeling, packaging and <br />sterliziin items correct) <br />I19. <br />Machines cleaned and disinfected between <br />clients <br />In61A <br />3. Autoclave loaded correctly/packages allowed to <br />dry <br />11 <br />0 <br />I20. <br />N/A <br />Parts replacedbetween clients - grommets, <br />elastic bands, etc. <br />0 <br />In tyQ <br />/A <br />4. Integrators used/monthly spore test/log <br />maintained <br />0 <br />PREVENTING CROSS CONTAMINATION11 <br />`: <br />In NIO <br />AP <br />5. Decontamination/sanitation area separate and <br />supplied * <br />In / <br />/A <br />21. Workstation/procedure area decontaminated <br />❑ <br />0 <br />In N/0 <br />N/A <br />6. Invoices and log kept for disposable, pre- <br />sterilized equipment, backup supplies available * <br />.� <br />In NIO <br />N/A <br />22. Chemical disinfectant used <br />Chemical used: <br />0 <br />0 <br />In N/0 <br />NIA <br />7. Sharps containers supplied, labeled, used and <br />disposed of correct) * <br />0 <br />InI <br />N/A <br />23. Disinfectant used sufficient contact time Wet <br />contact timeprovided: <br />& N/O <br />N/A <br />8. Jewelry, tattoo and piercing equipment - storage <br />and use <br />0 <br />0 <br />n N/0 <br />N/A <br />24. Barriers available and used as part of <br />procedure <br />:. PRACTITIONER HEALTH AND HYGIENE <br />Un N/O <br />NIA <br />25. Products applied to skin are single <br />use/dispensed aseptically <br />0 <br />0 <br />In N/0 <br />N/A <br />9. No eating, drinking or smoking - clean clothes <br />N/O <br />N/A <br />26. Storage of inks, pigments, needles, tubes, etc., <br />0 <br />0 <br />In N/0 <br />N/A <br />10. Hands washed effectively and timely <br />0 <br />0 <br />N10 <br />N/A <br />27. Jewelry, Inks, Needles etc approved and used <br />0 <br />0 <br />In N/O11. <br />N/A <br />Handwashing facilities properly supplied and <br />accessible, warm potable water * <br />In /0 <br />N/A <br />28. Cross -contamination avoided during all phases <br />of procedure <br />0 <br />0 <br />In N/0 <br />N/A <br />12. Personal protective equipment available and <br />used, a ewash station available * <br />0 <br />0 <br />BEST BUSINESS PRACTICE& <br />' ' �' <br />t , ` CUSTOMERSICLIENTS : <br />In N10 <br />N/Aquarters/no <br />29. Areas separated/no living or sleeping <br />animals <br />0 <br />0 <br />In NIO <br />N <br />13. Branding is completed with no other customers in <br />procedure area <br />0 <br />0 <br />In N/0 <br />/A <br />30. Floors and walls clean and in good repair, <br />adequate light * <br />0 <br />In N/0 <br />N/A <br />14. Customers eighteen (18) years of age or older <br />0 <br />0 <br />n N10 <br />N/A <br />31. Workstation, surfaces, including chairs, , etc. in <br />good repair; trash removed frequently * <br />In 1 <br />NIA <br />15. Skin prepared for procedure. <br />0 <br />In N/0 <br />N/A <br />32. Permit/registration and required signs posted <br />0 <br />In N/O <br />N/A <br />16. Client records available - Consent form & <br />questionnaire <br />aq <br />0 <br />In N/O <br />N/A <br />33. IPCP and employee training records and <br />He atitiis B vaccination status present <br />0 <br />In NIO <br />N/A <br />17. Aftercare instructions given to client <br />0 <br />In N/O <br />N/A <br />34 Restrooms available, stocked * <br />0 <br />0 <br />Received by (Print): Received by (Signature): Phone: <br />Specialist (Print): I' r,Y7�C� t4veA 7M. �jje;, Specialist (Signature):( Phone:c�t3��'elfi 'CJ`�7 <br />❑This report is an Official Notice of Violation. Corrections must be completed in the time specified. <br />A reinspection fee may be charged if violations noted on this report are not corrected by the reinspection date <br />Paged -of 6 <br />Reinspection Date (on or about) <br />