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---- --_ _ ------ ,o• oo Body Art Inspection Report Date(MM/DD/YY) %01%111 y County of San Joaquin County,Environmental Health Department 1868 E.Hazelton Ave.,Stockton CA 95205 Permit Number rJw ��sgj �• (209)468-3420 vAvw.sjgov.ora/ehd \ c. 103 Permit Type Facili Name Address C_ / City Zip Code o CT 4 f �JO OOd15 .7�►�D r1 pp nt7` 'G G S 0 W. ��H<tit(�Or n. ►SZ,1)r o4Atiu]�SG( ,nJ Permit/Registration Holder Name Permit Exp.Date Total Time Inspection Type RISK FACTORS AND INTERVENTIONS Risk factors are improper practices or procedures identified as contributing factors of crosscontamination. 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 TATTOOAND PERMANENT COSMETICS MACHINE CL EANINGAND:STERILIZATION .•. ws �. »ate- HIN - our cos- SAFETYAiJ�SAflITATION .,':� . _ In N/O 1. Autoclave is approved and effective-passed ❑ ❑ In N/0 ~ 18. Safe machine design our cos N/A integrator test N/A ❑ ❑ In N!0 2. Process of cleaning,labeling,packaging and ❑ El In N/0 19. Machines cleaned and disinfected between N/A sterliziin items correctly N/A clients ❑ ❑ In N/0 3. Autoclave loaded correctly/packages allowed to ❑ ❑ In NIO 20. Parts replaced between clients-grommets, N/A d N/A elastic bands,etc. ❑ ❑ In N!0 4. Integrators used/monthly spore test/log PREVENTING CROSS-CONTAMINATION' N/A maintained ❑ ❑ ;, In N10 5. Decontamination/sanitation area separate andN/0 N/A supplied* p ❑ ❑. In 21. Workstation/procedure area decontaminated ❑ ❑ In N/0 6. Invoices and log kept for disposable,pre- tee, ❑ In N/0 22. Chemical disinfectant used N/A sterilized equipment,backupsuplies available* ""l N/A Chemical used: ❑ ❑ In N/0 7. Sharps containers supplied,labeled,used and In Nl0. 23. Disinfectant used sufficient contact time Wet N/A disposed of correctly* El El N/A ❑ In N10 8. Jewelry,tattoo and piercing equipment-stora e N/A contact time roe ard: P 99 ❑ ❑ In N/O 24. Barriers available and used as part of NIA and use NIAprocedure* ❑ ❑ --PRACTITIONER* 'A'' In N/0 25. Products applied to skin are single HEALTH AND HYGIENE NIA use/dispensed aseptically ❑ ❑ In N/O 9. No eating,drinking or smoking-clean clothes In N/0 26. Storage of inks,pigments,needles,tubes,etc., N/A ❑ ❑ N/A ❑ ❑ In N/0 10. Hands washed effectively and timely ❑ 11InNtp/0 27. Jewelry,Inks,Needles etc approved and used ❑ ❑ N/A In N10 11. Handwashing facilities properly supplied and ❑ In N/0 28. Cross-contamination avoided during all phases N/A accessible,warm potable water* N/A of rocedure ❑ ❑ In N/O 12. Personal protective equipment available and BEST BUSINESS'PRACTICES' N/A used,a ewash station available* ❑ ❑ c°.`;+r �� s �w _ i CUSTOMERSICLIENTS r In N/O 29. Areas separated/no living or sleeping xau' exsd- fi a #til� .k dk s i .:s' „a»#� ' NIA uarters/no animals* ❑ ❑ In NIO 13. Branding is completed with no other customers in ❑ ❑ In NIO 30. Floors and walls clean and in good repair, N/A rocedure area N/A adequate light* ❑ ❑ In N/O 14. Customers eighteen(18)years of age or older ❑ In NIO 31. Workstation,surfaces,including chairs,,etc,in N/A N/A good repair;trash removed fre uentl ❑ ❑ In N/O 15. Skin prepared for procedure. ❑ In N!0 32. Permit/registration and required signs posted N/A N/A * ❑ In N/O 16. Client records available-Consent form& ❑ In N/0 33. IPCP and employee training records and N/A questionnaire N/A He atitiis B vaccination status present ❑ In N/0 17. Aftercare instructions given to client CK ❑ In N/0 34 Restrooms available,stocked NIA N/A ❑ ❑ eceived b (Print): Received b (Signature): Phone: pecialist(Print): Specialist(Signature): Phone: This report is an Official Notice of Violation.Corrections must be completed in the time specified. A reinspection fee may be charged if violations noted on this report are not corrected by the reinspection date. Reinspection Date(on or about) Pagel of 3