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Body Art Inspect*Report Date: 1 � ' / <br /> San Joaquin County Environmental Health Department Program 3�7 t� q <br /> www.siogv.orq/ehd <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 I Record: 20 1 I <br /> \ P: 468-3420 Program r , I z O <br /> \t!Foae�` ww. VI <br /> Element: <br /> Facility Name Address City Zip Code <br /> Word of Mouth 32 e.acacia st. Stockton 95202 <br /> Name of Permit/Registration Holder Permit Exp.Date Time In Time Out Inspection Type <br /> Sonny J.Brown 6/30/16 Re-inspection <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 ❑ ❑ 22 Parts replaced between clients-grommets,elastic bands, ❑ <br /> test etc. <br /> ❑ <br /> Items washed,disinfected,packaged, labeled,and 2' 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 ❑ ❑ 24. Appropriate chemical disinfectant used <br /> Decontamination/sanitation area separated and supplied ElEl 5' a ro riatel E] Chemical used: Cavicide <br /> ❑ <br /> Invoices and log kept for disposable,pre-sterilized 6' ❑ [j25. Disinfectant used appropriately/sufficient contact time <br /> equipment <br /> ElSharps containers labeled, used,and disposed of <br /> ® 7 E]appropriately <br /> [Wet contact time provided: 15-30 minz <br /> ❑ 8 Jewelry,tattoo and piercing equipment-clean and ❑ ❑ 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 /> El 11. warm water E] El 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: Cathy Montie ❑ 32. Floors and walls clean and in good repair,adequate light ❑ <br /> ❑ 14 Appropriate personal protective equipment available and ❑ ❑ 33 Workstation,surfaces,including chairs,armrests,etc.in Elused good repair <br /> CUSTOMERS/CLIENTS ❑ 34. Permit/registration posted ❑ <br /> Branding is completed with no other customers in <br /> F1 15. ❑ ❑ 35. Operation and employee training records present Elrocedure 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. iEl ❑ 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. El <br /> Received b (Print): Sonny J.Brown Received by(Signature): Phone: 209 915-7018 <br /> Specialist(Print): Har rit Mattu,Sr REHS Specialist Si nature): Phone: 209 468-3284 <br /> Reinspecion on/about: A reinspection fee of$130 per hour may be charged. Page 1 of 2 <br /> EH-03/2015 <br />