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t Body Art Inspect Report Date: -16 7— N� San Joaquin County Environmental Health Department Program D 1868 E. Hazelton Ave., Stockton, CA 95205 Record: r• �S S s P. (209) 468-3420 Program www.sioqv.org/ehd (,� Z7 6 Element: 1 L - 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 6/30/16 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 ❑ ❑ 22 Parts replaced between clients - grommets, elastic bands, Eltest etc. ❑ 2 Items washed, disinfected, packaged, labeled, and ❑ 16. sterilized ❑ 3. Autoclave loaded correctly/packages allowed to dry ❑ 4. Integrators used/monthly spore test/log maintained ❑ 5 Decontamination/sanitation area separated and supplied Appropriate chemical disinfectant used ❑ appropriately ❑ 6 Invoices and log kept for disposable, pre -sterilized Impoundment ❑ equipment ❑ 7 Sharps containers labeled, used, and disposed of Hearing scheduled Wet contact time provided: 3-5 mins appropriately ❑ 8 Jewelry, tattoo and piercing equipment - clean and Barriers used ❑ 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: Cathie Montie Body Art Training Company ❑ 14. Appropriate personal protective equipment available and CUSTOMERS/CLIENTS ❑ 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 Received Mattu, Sr REHS Received ❑ PREVENTING CROSS -CONTAMINATION ❑ ❑ 23. Workstation/procedure area decontaminated ❑ ❑ ❑ 24. Appropriate chemical disinfectant used ❑ ❑ Chemical used: Opticide ❑ Impoundment ❑ 25. Disinfectant used appropriately/sufficient contact time ❑ ❑ Hearing scheduled Wet contact time provided: 3-5 mins ❑ ❑ 26. Barriers used ❑ Ell ❑ 27. Products applied to skin are single use/dispensed asepticall ❑ ❑ ❑ 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 procedure ❑ ❑ BEST BUSINESS PRACTICES ❑ ❑ 31. Areas separated/no living or sleeping quarters ❑ ❑ 32. Floors and walls clean and in good repair, adequate light ❑ ❑ ❑ 33. Workstation, surfaces, including chairs, armrests, etc. in go repair ❑ ❑ 34. Permit/registration 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 ❑ Ell ❑ Reinspecion on/about: A reinspection fee of $130 per hour may be charged. EH -03/2015 647-4791 Page 1 of 2