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°Qq U'Nco Body Art Inspect Report • Date: 7,/Z 1/ I 5 <br /> San Joaquin County Environmental Health Department Program Co +f <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: 546 6 72 ! 7 3 <br /> o p (209)468-3420 <br /> Program <br /> '9<1Foai' wwwsio-qv.org/ehd g 4' b3 <br /> Element: <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 C. Fuentes Consultation <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 ❑ ❑ 713arts replaced between clients-grommets,elastic bands, Eltest etc. <br /> Items washed,disinfected,packaged,labeled,and <br /> El 2' sterilized F] PREVENTING CROSS-CONTAMINATION <br /> ❑ 3. Autoclave loaded correctly/packages allowed to dry ❑ ❑ 23. 1 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 /> ❑ 5. appropriately ❑ Chemical used: <br /> Invoices and log kept for disposable,pre-sterilized <br /> ® 6• El ® 25. Disinfectant used appropriately/sufficient contact time <br /> equipment <br /> ElSharps containers labeled,used,and disposed of <br /> ® 7' appropriately El Wet contact time provided: <br /> Jewelry,tattoo and piercing equipment-clean and <br /> El 8' El E]® 26. Barriers used <br /> sterilized <br /> Products applied to skin are single use/dispensed <br /> PRACTITIONER HEALTH AND HYGIENE El 27' asepticallyEl <br /> ❑ 9. No eating,drinking or smoking-clean clothes ❑ ® 28. Storage of inks,pigments,needles,tubes,etc. ❑ <br /> ❑ 10. Hands washed effectively and timely ❑ ❑ 29. Jewelry, Inks,Needles etc approved and used correctly ❑ <br /> Handwashing facilities properly supplied and accessible,® Cross-contamination avoided during all phases of 11. warm water ❑ ❑ 30' procedure El <br /> ❑ 12. Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES <br /> ® 13. Bloodborne Pathogen trainingEl ® 31. Areas separated/no living or sleeping quarters ❑ <br /> Source: ® 32. Floors and walls clean and in good repair,adequate light ❑ <br /> ® <br /> Appropriate personal protective equipment available and Workstation,surfaces,including chairs,armrests,etc.in 14. used El ® 33' good repair <br /> E] <br /> CUSTOMERS/CLIENTS ❑ 34. Permit/registration posted ❑ <br /> ❑ <br /> Branding is completed with no other customers in 15. ❑ ® 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 /> ® <br /> Client records approved and available-Consent form 18. ElEl❑ 37. Permits obtained and available <br /> 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 I ❑ I ❑ 1 41. ❑ <br /> Received b Print): e' S Received b Si nature): Phone:>-os- (�_ y7 <br /> �j <br /> Specialist(Print): (`u Specialist(Signature): Phone: O - ' -1 <br /> Reinspecion on/about: A reinspection fee of$130 per hour may be charged. Page 1 of 3 <br /> EH-03/2015 <br />