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_W 2 / I <br /> cps Body Art InspectieReport Date: / 19 <br /> z San Joaquin County Environmental Health Department Program <br /> PRO SN (q08 <br /> t 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: <br /> ' (209)468-3420 Programu <br /> _<<Fb. e�.r www.siogv.org/ehd 1 12(7 <br /> Element: <br /> Facility Name Address City Zip Code <br /> Kym with a Y Organic Spa&Waxing 307b lincoln center Stockton 95207 <br /> Name of Perm it/Registration Holder Permit Exp. Date Time In Time Out Inspection Type <br /> Kymberleigh Thompson 6/30/19 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(cont) C <br /> ❑ 1 Autoclave:approved and effective-passed integrator [j ❑ 22 Parts replaced between clients-grommets,elastic bands, ❑ <br /> test etc. <br /> ❑ <br /> Items washed,disinfected,packaged,labeled,and 2' sterilized E] PREVENTING 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 ❑ ❑ 24. Appropriate chemical disinfectant used <br /> Decontamination/sanitation area separated and supplied ❑ <br /> ❑ 5. E] Chemical used: Sani-Cloth Plus and Citrus II <br /> appropriately <br /> 6. <br /> ro riatel <br /> ® <br /> Invoices and log kept for disposable,pre-sterilized 6• rE01 <br /> ❑ 25. Disinfectant used appropriately/sufficient contact time <br /> equipment ElSharps containers labeled,used,and disposed of <br /> ❑ 7 a pro riatel Wet contact time provided: 3 mins and 5 mins <br /> El 8. Jewelry,tattoo and piercing equipment-clean and <br /> ❑ 26. Barriers used Elsterilized <br /> Products applied to skin are single use/dispensed <br /> PRACTITIONER HEALTH AND HYGIENE ❑ 27 asepticallyE] <br /> ❑ 9. No eating,drinking or smoking-clean clothes rEE11 <br /> El 28. Storage of inks,pigments,needles,tubes,etc. 110 10. Hands washed effectively and timely ❑ 29. Jewelry,Inks,Needles etc approved and used correctly E311 Handwashing facilities properly supplied and accessible, ross-contamination avoided during all phases of <br /> warm water El30' procedure El <br /> ❑ 12. Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES <br /> ❑ 13. Bloodborne Pathogen trainingElEl1331. Areas separated/no living or sleeping quarters <br /> Source: AboveTraining.com ❑ 32. Floors and walls clean and in good repair,adequate light ❑ <br /> ❑ <br /> Appropriate personal protective equipment available and Workstation,surfaces,including chairs,armrests,etc.in El14. used El ❑ 33. goo d repair <br /> CUSTOMERSICLIENTS ❑ 34• Permit/registration posted ❑ <br /> ❑ 15. Branding is completed with no other customers in <br /> rocedure area El ® 35. Operation and employee training records present El <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 /> ® 18 Client records approved and available-Consent form <br /> ❑ El 37. Permits obtained and available Eland 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. ❑ <br /> Received b (Print): K mberlei h Thompson Received by(Signature): Phone:(209)952-2299 <br /> Specialist(Print): Mai Vue Specialist(Signature): Phone: 209 468-3284 <br /> Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Page 1 of 2 <br /> EH-11/17 <br />