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\ Body Art Inspect`Report Date: <br /> �1 San Joaquin County Environmental Health Department Program fib �3� lo(o� <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: <br /> *� <br /> �.- <br /> 4 (209)468-3420 <br /> Program �f <br /> rF"71 www.siogv.orp �/ g/ehd Wg -/f 2-6 <br /> Ele nt: <br /> Facility Name Address City Zip Code <br /> Secret Sidewalk Tattoo 8 west eleventh st. Tracy 95376 <br /> Name of Permit/Registration Holder Permit Exp.Date Time In Time Out Inspection Type <br /> Eddie Reyes 6/30/20 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 Parts replaced between clients-grommets,elastic bands, ❑ <br /> test El ❑ 22. etc. <br /> ❑ 2 Items washed,disinfected,packaged,labeled,and <br /> 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 ❑ [:1 24. Appropriate chemical disinfectant used <br /> ❑ 5 Decontamination/sanitation area separated and supplied ❑ <br /> E] Chemical used: <br /> appropriately <br /> 6. <br /> ro riatel <br /> ® <br /> Invoices and log kept for disposable,pre-sterilized 6. El ❑ 25. Disinfectant used appropriately/sufficient contact time <br /> equipment <br /> El <br /> ❑ 7 Sharps containers labeled,used,and disposed of <br /> appropriately <br /> ❑ [Wet contact time provided: <br /> ❑ 8 Jewelry,tattoo and piercing equipment-clean and <br /> El 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 /> ❑ 10. Hands washed effectively and timely ❑ ❑ 29. Jewelry,Inks,Needles etc approved and used correctly ❑ <br /> Handwashing facilities properly supplied and accessible, Cross-contamination avoided during all phases of <br /> ❑ 11. warm water ❑ ❑ 30. procedure <br /> El <br /> ❑ 12. Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES <br /> ® 13. Bloodborne Pathogen training ❑ ❑ 31. Areas separated/no living or sleeping quarters ❑ <br /> Source: ❑ 32. Floors and walls clean and in good repair,adequate light ❑ <br /> Appropriate personal protective equipment available and Workstation,surfaces,including chairs,armrests,etc.in <br /> El 14. used ❑ ❑ 33' good repair ❑ <br /> CUSTOMERS/CLIENTS ❑ 34. Permittregistration posted ❑ <br /> Branding is completed with no other customers in <br /> El 15. 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 /> ® <br /> Client records approved and available-Consent form 18. El El 37. Permits obtained and available <br /> and questionnaire <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. y �y QEl <br /> Received b (Print): adq Received b (Signature): Phon <br /> Specialist(Print): J.Easter Specialist Si nature: Phone: 209 953-7310 <br /> Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Page 1 of 3 <br /> EH-11/17 �( <br />