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`" coi Body Art Inspect*Report i Date: //Zo� <br /> San Joaquin County Environmental Health Department Program p <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: P R 53 7 <br /> (209)468-3420 <br /> ww.siogv.org/ehd Program <br /> wf 7-0Element: <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 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 Parts replaced between clients-grommets,elastic bands, <br /> test El ❑ 22' Eletc. <br /> ❑ 2 Items washed,disinfected,packaged,labeled,and <br /> sterilized E] PREVENTING CROSS-CONTAMINATION <br /> ❑ 3. Autoclave loaded correctly/packages allowed to dry [j ❑ 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 /> El 5" ❑ Chemical used: Cavicide <br /> appropriately <br /> 6. <br /> ro riatel <br /> ® <br /> Invoices and log kept for disposable,pre-sterilized 6• equipment El El25. Disinfectant used appropriately/sufficient contact time <br /> ElSharps containers labeled,used,and disposed of <br /> ® 7• ❑ Wet contact time provided: 15-30 mins <br /> appropriately <br /> Jewelry,tattoo and piercing equipment-clean and <br /> El 8' El El 26. Barriers used E]sterilized <br /> Products applied to skin are single use/dispensed <br /> PRACTITIONER HEALTH AND HYGIENE El 27' ase tical) El <br /> ❑ 9. No eating,drinking or smoking-clean clothes ❑ ❑ 28. Storage of inks,pigments,needles,tubes,etc. ❑ <br /> ❑ 10. Hands washed effectively and timely [I ❑ 29. Jewelry,Inks,Needles etc approved and used correctly ❑ <br /> Handwashing facilities properly supplied and accessible, Cross-contamination avoided during all phases of <br /> ❑ 11. warm water E] ❑ 30' procedure El <br /> rEl 12. Hepatitis B vaccination ElBEST BUSINESS PRACTICES <br /> 13. Bloodborne Pathogen training ❑ 31. Areas separated/no living or sleeping quarters ❑ <br /> Source: International CPR Institute ❑ 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 E]used good repair <br /> CUSTOMERS/CLIENTS ❑ 34. Permit/registration posted ❑ <br /> Branding is completed with no other customers in <br /> [j 15. F1 ® 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 /> Client records approved and available-Consent form <br /> ® 18. ElEl37. 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): Sonny J.Brown Received b Si nature: e: 209 915-7018 <br /> Specialist(Print): Harit Mattu,Sr REHS Specialist(Signa" Phone: 209 468-3284 <br /> u <br /> Reinspecion onlabout: -I Z81 A reinspection fee of$130 per hour may be charged. Page 1 of 2 <br /> EH-03/2015 <br />