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I <br /> Body Art Ins ec Re <br /> Y P Port <br /> Date: <br /> San Joaquin County Environmental Health Department Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: <br /> (209)468-3420 <br /> Program <br /> www.sjogv.org/ehd Element: Lit a <br /> Facility Name Address City Zip Code <br /> UpTown Ink 3206 pacific ave Stockton 95207 <br /> Name of Permit/Registration Holder Permit Exp.Date Time In Time Out Inspection Type <br /> Cesar Flores 6/30/14 Routine <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 /> Ej 1 Autoclave:approved and effective-passed integrator ❑ ❑ 22 Par1sre,laced between clients-grommets,elastic bands, ❑test <br /> Items washed,disinfected,packaged,labeled,and <br /> ® 2. sterilized E] PREVENTING 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 ❑ [1 24. Appropriate chemical disinfectant used <br /> ElDecontamination/sanitation area separated and supplied <br /> ❑ 5' ElChemical used: Madacide FD <br /> appropriatelyInvoices and log kept for disposable,pre-sterilized El 6' ui <br /> equipment ❑ ❑ 25. Disinfectant used appropriately/sufficient contact time <br /> 1:1Sharps containers labeled,used,and disposed of <br /> ® 7� ❑ Wet contact time provided: <br /> appropriately❑ <br /> Jewelry,tattoo and piercing equipment-clean and 8' El El 26. Barriers used <br /> sterilized <br /> Products applied to skin are single use/dispensed <br /> PRACTITIONER HEALTH AND HYGIENE ® 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 El <br /> ® 11. warm water El ® 30. procedure <br /> ❑ 12. Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES <br /> ® 13. Bloodbome Pathogen training ❑ ❑ 31. Areas separated/no living or sleeping quarters ❑ <br /> Source: ❑ 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. Permit/registration posted ❑ <br /> ❑ <br /> Branding is completed with no other customers in 15. E] ® El35. 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. Plan(s)submitted for review ❑ <br /> ® <br /> Client records approved and available-Consent form 18. El El 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. 1 Safe machine design ❑ ❑ 40. Closure ❑ <br /> ❑ 21. 1 Machines Leaned and disinfected between clients ❑ I ❑ 41. ❑ <br /> Received b (Print): Cesar Flores Received by(Signature): ! ;2_-___Phone: Z y -J2 00 <br /> Specialist(Print): Afonso Arambula Specialist(Signature): Phone: 209 468-9673 <br /> Reinspecion on/about: A reinspection fee of$125 per hour may c�aVold. Page 1 of 3 <br /> EH-04/2014 <br />