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P4 o Body Art Ins ectoReport Date: S)ZA <br /> S San Joaquin County Environmental Health Department Program <br /> 2 <br /> m 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: \ �c. �2 J 10-5 <br /> (209)468-3420 Program U ` <br /> trF�a`P. www.sioay.org/ehq Element: <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 6/30/15 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 /> 7ettri <br /> ❑ 1e:approved and effective-passed integrator ❑ ❑ 22 Parts replaced between clients-grommets,elastic bands,etc. <br /> shed,disinfected,packaged, labeled,and❑ 2 ❑ <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 Chemical used: Madacide ❑ <br /> ❑ 5' <br /> appropriately <br /> ❑ <br /> Invoices and log kept for disposable,pre-sterilized <br /> ® 6• equipment ❑ ❑ 25. Disinfectant used appropriately/sufficient contact time <br /> El <br /> ❑ 7 Sharps containers labeled,used,and disposed of ❑ Wet contact time provided: 3 minutes <br /> appropriately <br /> Jewelry,tattoo and piercing equipment-clean and <br /> ❑ 8' sterilized ❑ ❑ 26. Barriers used ❑ <br /> Products applied to skin are single use/dispensed <br /> T. _. El 27' <br /> 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 /> ❑ 11 Handwashing facilities properly supplied and accessible, ❑ ❑ 30 Cross-contamination avoided during all phases of ❑ <br /> warm water rocedure <br /> ❑ 12. Hepatitis B vaccination ❑ g WSW- <br /> El <br /> SS,,.. P, T <br /> ❑ 13. Bloodborne Pathogen training ❑ ❑ 31. Areas separated/no living or sleeping quarters ❑ <br /> Source: Cathy Montie ❑ 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 /> 0„,.E IE 19 <br /> ® 34. Perm it/reg istratio n posted El <br /> ❑ 15 Branding is completed with no other customers in ❑ bd 35. Operation and employee training records present ❑ <br /> procedure area <br /> ❑ 16. Customers eighteen(18)years of age or older ❑ NIELEYPORROMEN,MRS <br /> ❑ 17. Skin adequately prepared for procedure ❑ ❑ 36. Plan(s)submitted for review ❑ <br /> Client records approved and available-Consent form <br /> ;[E:l <br /> 18. and uestionnaireEl El37. Permits obtained and available El 19. Appropriate aftercare instructions given to client ❑ ❑ 38. Impoundment ❑ <br /> EWEr 174 NA .I to El39. Hearing scheduled El <br /> ❑ 20. Safe machine design ❑ ❑ 40. Closure ❑ <br /> ❑ 21. Machines cleaned and disinfected between clients ❑ ❑ 41. ❑ <br /> 71, <br /> Received b (Print): Cesar Flores Received b (Si nature): '� ' Phone: 209 466-1200 <br /> t <br /> Specialist Print): Har rit 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 />