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Body Art Inspects Report • Date: (/� A <br /> San Joaquin County Environmental Health Department Program �7 <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: S 00 72 7/ 3' <br /> (209)468-3420 <br /> p Program rC>] <br /> www.siogv.oro/ehd `I <br /> Element: Li b <br /> Facility Name Address City Zip Code <br /> Legendary Tattoo 330 w.lodi ave#a Lodi 95240 <br /> Name of Permit/Registration Holder Permit Exp.Date Time In Time Out Inspection Type <br /> Jay Fuentes Final Consult. <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 I etc. <br /> Items washed,disinfected,packaged,labeled,and <br /> ❑ 2' sterilized 1:1PREVENTING 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 ❑ <br /> El 5' ❑ Chemical used: Cavicide <br /> appropriatelyInvoices and log kept for disposable,pre-sterilized <br /> ® 6. equipment ❑ [E] 25. Disinfectant used appropriately/sufficient contact time <br /> Sharps containers labeled, used,and disposed of ❑7' appro riatel ❑ Wet contact time provided: 5-10 <br /> Jewelry,tattoo and piercing equipment-clean and❑ 8' sterilized ❑ 26. Barriers usedProducts applied to skin are single use/dispensed <br /> PRACTITIONER HEALTH AND HYGIENE 27. ase ticall 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 ❑Handwashing facilities properly supplied and accessible, ❑ 30 Cross-contamination avoided during all phases of ❑ <br /> warm water procedure <br /> ❑ 12. Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES <br /> ❑ 13. Bloodborne Pathogen training ❑ [:1 1 31. Areas separated/no living or sleeping quarters ❑ <br /> Source: Above Training ® 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 ❑ <br /> used good repair <br /> CUSTOMERS/CLIENTS ❑ 34. Perm it/registration posted E] <br /> Branding is completed with no other customers in <br /> ❑ 15. El El® 35. Operation and employee training records present <br /> procedure area <br /> ❑ 16. Customers eighteen(18)years of age or older ❑ COMPLIANCE AND ENFORCEMENT <br /> ❑ 17. Skin adequately prepared for procedure ❑ ❑ 36. 1 Plan(s)submitted for review ❑ <br /> Client records approved and available-Consent form <br /> ® 18. El [_137. Permits obtained and available E]and 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): Sal Mireles Received by(Signature). Phone: 209 747-7347 <br /> Specialist(Print): Harprit Mattu Sr REHS Specialist(Signature): 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 />