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a i <br />Body Art Inspection Report Date (MM/DD/YY) /V - / 7 -/ 3 <br />y County of San Joaquin County, Environmental Health Department <br />Permit Number SR B Old <br />lass E. Hazelton Ave., Stockton CA 95205 <br />(209) 468-3420 NnNVJ.sigoy.orq/ehd <br />Permit Type <br />FacilityName Address City Zip Code CT <br />'_ �-r.. 1 _- o Bio) &i . E {��.��C -STEL �Sfi��l vn c sd09" <br />Permit/Registra ion Holder Name Permit Exp. Date Total Time Inspection Type <br />vk, -4i,2:, <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 />tY <br />f <br />C =E -v ENTCOSMETICSMACHINE ' <br />6 <br />': CLEANING AND STERILIZATION g., ¢„ <br />�p, <br />s' <br />t F S a S ATI N ri e our cos <br />In <br />1. Autoclave is approved and effective - passed <br />❑ <br />13 <br />n N/0 <br />18. Safe machine design <br />El <br />11 <br />NiA <br />integrator test <br />NIA <br />In <br />2. Process of cleaning, labeling, packaging and <br />In N/0 <br />19. Machines cleaned and disinfected between <br />❑ <br />0 <br />NIA <br />sterlizilng items correctly <br />NIA <br />clients <br />In ' -IVO <br />3. Autoclave loaded correctly/packages allowed to <br />[3 <br />13 <br />In N10 <br />20. Parts replaced between clients - grommets, <br />0 <br />0 <br />IA <br />dry <br />NIA I <br />elastic bands, etc. <br />In <br />4. Integrators used/monthly spore test/log <br />REVS (NG;CROSS=CONTAMINATION . <br />JA <br />maintained. <br />` <br />In 0 <br />5. Decontamination/sanitation area separate and <br />El <br />O <br />In N/0 <br />21. Workstation/procedure area decontaminated <br />0 <br />11 <br />l <br />supplied * <br />N/A <br />/0 <br />6. Invoices and log kept for disposable, pre- <br />11 <br />0 <br />In N/O <br />22. Chemical disinfectant used <br />0 <br />11 <br />N/A <br />sterilized equipment, backu supplies available * <br />N/A <br />Chemical used: <br />N/0 <br />7. Sharps containers supplied, labeled, used and <br />In N/0 <br />23. Disinfectant used sufficient contact time Wet <br />13 <br />11 <br />N/A <br />disposed of correct) * <br />/A <br />contact timeprovided: <br />In N/0 <br />8. Jewelry, tattoo and piercing equipment - storage <br />0 <br />11 <br />N/0 <br />N/A <br />24. Barriers available and used as part of <br />El <br />13 <br />NIA <br />and use <br />rocedure * <br />In NIO <br />25. Products applied to skin are single <br />❑ <br />El <br />PRACTITIONER HEALTH AND HYGIENE <br />A <br />useldis ensed aseptically <br />N/0 <br />UA <br />9. No eating, drinking or smoking -clean clothes <br />n N/0 <br />26. Storage of inks, pigments, needles, tubes, etc., <br />0 <br />N/A <br />In N/0 <br />10. Hands washed effectively and timely <br />0 <br />0 <br />In NIO <br />27. Jewelry, Inks, Needles etc approved and used <br />0 <br />11 <br />,NIA <br />N/A <br />In N10 <br />11. Handwashing facilities properly supplied and <br />0 <br />11 <br />In NIO <br />28. Cross -contamination avoided during all phases <br />13 <br />11 <br />A <br />accessible, warm potable water * <br />NIA <br />I of procedure <br />In N/0 <br />12. Personal protective equipment available and <br />BEST BUSINESS PRACTICES xu <br />N/A <br />used, eyewash station available <br />CUSTOMERSICLIENTS z <br />In NIO <br />29. Areas separated/no living or sleeping <br />0 <br />11 <br />quarters/no animals <br />In <br />13. Branding is completed with no other customers in <br />❑ <br />❑ <br />0 <br />30. Floors and walls clean and in good repair, <br />El <br />11 <br />N/procedure <br />area <br />I <br />N/A <br />adequate light * <br />In /0 <br />14. Customers eighteen (18) years of age or older <br />11 <br />0 <br />n N/0 <br />31. Workstation, surfaces, including chairs, , etc. in <br />N/A <br />/A <br />good repair; trash removed frequently <br />In N/0 <br />15. Skin prepared for procedure. <br />011 <br />(/InN10 <br />32. Permit/registration and required signs posted' <br />0 <br />0 <br />N/A <br />N/A <br />In NIO <br />16. Client records available - Consent form & <br />n N/0 <br />33. IPCP and employee training records and <br />NIA <br />uestionnaire <br />NIA <br />He atitiis B vaccination status present <br />In N/0 <br />17. Aftercare instructions given to client <br />0 <br />n N/0 <br />34 Restrooms available, stocked <br />NIA <br />I NIA <br />Received by (Print): Received by (Signature): Phone: <br />Specialist (Print): Specialist (Signature): Phone: <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. Reinspection Date (on or about) <br />Page I of 3 <br />