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Body Art Inspect* Report P P � Y Date: 1C7-Ott-t.L( Q " Z San Joaquin County Environmental Health Department Program s 1868 E. Hazelton Ave., Stockton, CA 95205 Record: 209 468-3420 ( ) Program a www.siogv.org/ehd Element: 411 CU t� t Facility Name Address City Zip Code One Sixteen Tattoo 181 s union rd ste 105 Manteca 95337 Name of Permit/Registration Holder Permit Exp. Date Time In Time Out Inspection Type Stephen Thompson Consultation The above facility is inspected for compliance with Division 104, Part 15, Chapter 7 of California Health and Safety Code (HSC). V = Violation C = Corrected On Site V CLEANING AND STERILIZATION C V MACHINE SAFETY AND SANITATION (cont.) C ❑ 1 Autoclave: approved and effective - passed integratorE] ❑ 22 Parts replaced between clients - grommets, elastic bands, El etc. F] 2. Items washed, disinfected, packaged, labeled, and El sterilized CROSS -CONTAMINATION ❑ 3. Autoclave loaded correctly/packages allowed to dry ❑ ❑ 23. Workstation/procedure area decontaminated ❑ ❑ 4. Integrators used/monthly spore test/log maintained ❑ ® 24. Appropriate chemical disinfectant used ❑ El 5' Decontamination/sanitation area separated and supplied ❑ Chemical used: a ro riatel ® 6• Invoices and log kept for disposable, pre -sterilized El El25. Disinfectant used appropriately/sufficient contact time equipment ElSharps ® 7' containers labeled, used, and disposed of ❑ Wet contact time provided: aro riatel F, 8' Jewelry, tattoo and piercing equipment - clean and E] 26. Barriers used El® sterilized ❑ 27. Products applied to skin are single use/dispensed PRACTITIONER HEALTH AND HYGIENE asepticallyEl ❑ 9. No eating, drinking or smoking - clean clothes ❑ ® 28. Storage of inks, pigments, needles, tubes, etc. ❑ ❑ 10. Hands washed effectively and timely ❑ ❑ 29. Jewelry, Inks, Needles etc approved and used correctly ❑ ® 11' Handwashing facilities properly supplied and accessible, ❑ El 30. Cross -contamination avoided during all phases of El warm water procedure ❑ 12. 1 Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES ❑ 13. Bloodbome Pathogen training El 31. Areas separated/no living or sleeping quarters El ❑ Source: ® 32. Floors and walls clean and in good repair, adequate light E]Appropriate ® 14. personal protective equipment available and ❑ ® 33. Workstation, surfaces, including chairs, armrests, etc. in ❑ used good repair CUSTOMERS/CLIENTS ❑ 34. Permit/registration posted ❑ E] 15. Branding is completed with no other customers in ❑ ® 35. Operation and employee training records present ❑ procedure area ❑ 16. Customers eighteen (18) years of age or older ❑ COMPLIANCE AND ENFORCEMENT ❑ 17. Skin adequately prepared for procedure ❑ ❑ 36. Plan(s) submitted for review ❑ ® 18. Client records approved and available - Consent form [j❑ 37. Permits obtained and available ❑ and uestionnaire ® 19. Appropriate aftercare instructions given to client [1 [j 38. Impoundment ❑ MACHINE SAFETY AND SANITATION ❑ 39. Hearing scheduled ❑ ❑ 20. Safe machine design ❑ ❑ 40. Closure ❑ ❑ 21. Machines cleaned and disinfected between clients ❑ ❑ 41. ❑ Keceivea Page 1 of 3 EH -04/2014 ►. MZ40111