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N11 In accordance with the California Health and Safety Code, Section 119313, a body art facility shall maintain and follow a written Infection Prevention and Control Plan, provided by the owner or established by the practitioners, specifying procedures to achieve compliance with the Safe Body Art Act. A copy of the Infection Prevention and Control Plan shall be filed with the Local Enforcement Agency and a copy maintained in the body art facility. The body art facility owner shall provide onsite training on the facility's Infection Prevention and Control Plan to the body art practitioners and employees or individuals involved with decontamination and sterilization procedures. Training shall be provided when tasks where occupational exposures may occur are initially assigned, anytime there are changes in the procedures or tasks and when new technology is adopted for use in the body art facility, but not less than once each year. Records of training shall be maintained on-site for three years. The Infection Prevention and Control Plan shall be maintained current and updated whenever there are changes to any of the procedures or tasks listed and when new technology is adopted for use in the facility. Name of Body Art Facility: 6 o Yc I -Y 7-c', }- i S Site Address: _70 7 64 A-rz C R L/J L( City, State, Zip: 3L22C 15-+004J CA c 5-r2 0 -7 Type of Body Art Facility: rpt of _tOQ/AJ " Contact Person: Elie X S l-lr Uc(r're e� _ Telephone: - I A. Decontamination and Disinfection: Describe the procedures for decontaminating and disinfecting of workstation and surfaces. (California Health and Safety Code 119308 (b) and 119309 (a)(b)(c)(d)(e)) 1. Workstation surfaces/counter tops: U 5e M cic, G r e +o S i - +F ?o m s,U 5 a 4jpFC Lvi+h s7n,!!3ie C)SC Re. Pei- L -.,e1 4ben yrs -Ce, -,IF 2. Workstation chairs/stools: a e- crs nomber l Page 1 of 10