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ori Body Art Inspect Report Date: San Joaquin County Environmental Health Department Program 1868 E. Hazelton Ave., Stockton, CA 95205 S 3i 6SS (209) 468-3420 Program www.siogv.org/ehd g Element: 'A ZO 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 6/30/15 3:05pm 4:05pm Final/Routine 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 integrator Parts replaced between clients - grommets, elastic bands, ❑ test ❑ ❑ 22' etc. El 2' Items washed, disinfected, packaged, labeled, and El ❑ 10. sterilized ❑ ❑ 3. Autoclave loaded correctly/packages allowed to dry ❑ ❑ 4. Integrators used/monthly spore test/log maintained ❑ E3 5' Decontamination/sanitation area separated and supplied ❑ appropriatelyE3 ❑ 6 Invoices and log kept for disposable, pre -sterilized ❑ equipment ❑ 7' Sharps containers labeled, used, and disposed of El appropriately ❑ 8 Jewelry, tattoo and piercing equipment - clean and ❑ sterilized PRACTITIONER HEALTH AND HYGIENE ❑ 9. No eating, drinking or smoking - clean clothes ❑ ❑ 10. Hands washed effectively and timely ❑ ❑ 11. Handwashing facilities properly supplied and accessible, warm water ❑ ❑ 12. Hepatitis B vaccination ❑ ❑ 13. Bloodborne Pathogen training ❑ Source: Cathy Montie Body Art Training Company ❑ 14 Appropriate personal protective equipment available and _a ❑ CUSTOMERS/CLIENTS El 15. Branding is completed with no other customers in procedure area ❑ ❑ 16. Customers eighteen (18) years of age or older ❑ ❑ 17. Skin adequately prepared for procedure ❑ ❑ 18. Client records approved and available - Consent form and questionnaire ❑ ❑ 19. Appropriate aftercare instructions given to client ❑ MACHINE SAFETY AND SANITATION ❑ 20. Safe machine design ❑ 21. Machines cleaned and disinfected between clients PREVENTING CROSS -CONTAMINATION ❑ 1 23. 1 Workstation/procedure area decontaminated ❑ ❑ 24. Appropriate chemical disinfectant used Chemical used: Madacide El ❑ 1 25. I Disinfectant used appropriately/sufficient contact time ❑■ Wet contact time provided: 5 mins ❑ 1 26. Barriers used ❑ El 27. Products applied to skin are single use/dispensed asepticallyEl ❑ ❑ 28. Storage of inks, pigments, needles, tubes, etc. ❑ ❑ 29. Jewelry, Inks, Needles etc approved and used correctly ❑ ❑ 30. Cross -contamination avoided during all phases of ❑ BEST BUSINESS PRACTICES ❑ 1 31. Areas separated/no living or sleeping quarters ❑ 37. 32. Floors and walls clean and in good repair, adequate light ❑ ❑ r❑ 33. Workstation, surfaces, including chairs, armrests, etc. in ood repair ❑ ❑ 34. Perm ittregistration posted ❑ ❑ 35. Operation and employee training records present ❑ COMPLIANCE AND ENFORCEMENT ❑ 36. Plan(s) submitted for review ❑ 37. Permits obtained and available ❑ 38. Impoundment ❑ 39. Hearing scheduled ❑ 40. Closure ❑ 1 41. 70z• S7, •Z36Z Received b (Print): Stephen Thompson Received b Si nat Phone: 209-6474791 Specialist (Print): Harprit Mattu Specialist (Signature): Phone: 209-468-3284 Reinspecion on/about: A reinspection fee of $125 per hour may charged. Page 1 of 2 EH -04/2014