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• • Date(MM/DD/YY) ll"�7 t l Body Art Inspection Report y County of San Joaquin County,Environmental Health Department i 1868 E.Hazelton Ave.,Stockton CA 95205 Permit Number (209)468-3420 www.sigov.org/ehd Permit Type 411:20 qG%FORS Facility Name Address City Zip Code CT wr,�,ky`Tlevt l h 4tCr, 316 Ctn6e IS't -TaLt &d ifSc, Uc!$ Permit/Registration Holder Name Permit Exp.bate Total Time Inspection Type ID 11 A*Ac T t5L%wuV� RISK FACTORS AND INTERVENTIONS Risk factors are improper practices or procedures identified as contributing factors of cross-contamination. Interventions are control measures to prevent cross-contamination and transfer of pathogens from one person to another. In=In Compliance Out=Not in Compliance N/0=Not Observed N/A=Not Applicable COS=Corrected On Site TATTOO AND PERMANE,. COSCS MACHINE ... ..GLEANING AND STERILIZATION SAFETY AND SANITATIO OUT cos In 10 1. Autoclave is approved and effective-passed In NIO 18. Safe machine design N/ integrator test IA In N10 2. Process of cleaning,labeling,packaging andt7 In N/0 19. Machines cleaned and disinfected between 0 11 sterliziing items correct) N/ clients In 0 3. Autoclave loaded correctly/packages allowed to 0 El In I 20. Parts replaced between clients-grommets, 0 13 %A dry N/A elastic bands,etc. In <0 4. Integrators used/monthly spore test/log P 0 GROSS CONTAMINATIO . (RA) maintained In 5. Decontamination/sanitation area separate and 0 0 In NIO 21, Workstation/procedure area decontaminated T O& /A supplied* N/A In /0 6. Invoices and log kept for disposable,pre- In N/0 22. Chemical disinfectant used N/A sterilized equipment,backu supplies available* N/A Chemical used: In N/0 7. Sharps containers supplied,labeled,used and El In I 23. Disinfectant used sufficient contact time Wet 11 11 IA disposed of correct) * N/A contact timeprovided: 'N N/0 8. Jewelry,tattoo and piercing equipment-storage LIn 24. Barriers available and used as part of 0 0 NIA and use procedure 25. Products applied to skin are single 0 El PRACTITIONER HEALTH AND HYGIENE use/dispensed aseptically In N/O 9. No eating,drinking or smoking-clean clothes 26. Storage of inks,pigments,needles,tubes,etc., NI In 10 10. Hands washed effectively and timely 27. Jewelry,Inks,Needles etc approved and used NIA In N/0 11. Handwashing facilities properly supplied and 28. Cross-contamination avoided during all phases ,-,N/A accessible,warm potable water* N/A of procedure 11 0 In NIO 12. Personal protective equipment available and BEST BUSINMS",F11 El itAG1 N/A used,eyewash station available CUSTOMERSICLIENTS I N/0 29, Areas separated/no living or sleeping 0 0 4-.. N/Aquarters/no animals In 90 13. Branding is completed with no other customers in 0 ❑ In N/0 30. Floors and walls clean and in good repair, %Aprocedure area /A adequate light* n /0 14. Customers eighteen(18)years of age or older 0 0 I N/0 31. Workstation,surfaces,including chairs,,etc.in ❑ ❑ / A good repair;trash removed frequently InNV 15. Skin prepared for procedure. ❑ 0 (In,/N10 32 . Permit/registration and required signs posted In N/0 16. Client records available-Consent form& In N/O 33. IPCP and employee training records and N/A uestionnaire /A He atitiis B vaccination status resent In N/0 17. Aftercare instructions given to client 14 N/0 34 Restrooms available,stocked 13 N/A N/A Received b (Print): f y��'�Received b : Si nature -� hone: Specialist(Print): 1 , Zt 1I h Specialist(Signature): Phone: t'`/f �G This report is an Official Notice of Violation.Corrections must be completed in the ti e s ci d. F1 A reinspection fee may be charged if violations noted on this report are not corrected by the reinspection date. Reinspection Date(on or about) Page # of i