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;oPUIN' o Body Art InspectiReport Date: <br /> a San Joaquin County Environmental Health Department Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: Cj I b �Li <br /> c ,p (209)468-3420 Program 1-7 0-b <br /> q �co'Ra www.siogv.org/ehd Element: <br /> Facility Name Address City Zip Code <br /> Mudville Tat2 Studio 127 w.harding way#a Stockton 95204 <br /> Name of Permit/Registration Holder Permit Exp. Date Time In Time Out Inspection Type <br /> Gustavo Hurtado Initial 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 /> ❑ 1 Autoclave:approved and effective-passed integrator ❑ ❑ 22 Parts replaced between clients-grommets,elastic bands, ❑ <br /> test etc. <br /> Items washed,disinfected,packaged,labeled,and <br /> ❑ 2' sterilized El 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 Chemical used: Madacide ❑ <br /> ❑ 5' appropriately ❑ <br /> Invoices and log kept for disposable,pre-sterilized <br /> ® 6• equipment ❑ ❑ 25. Disinfectant used appropriately/sufficient contact time <br /> Sharps containers labeled,used,and disposed of El® 7' a ropriatel E] 25. <br /> contact time provided: 6 mins <br /> Jewelry,tattoo and piercing equipment-clean and <br /> ❑ 8' sterilized El El 26. Barriers used ❑ <br /> Products applied to skin are single use/dispensed <br /> PRACTITIONER HEALTH AND HYGIENE ❑ 27' aseptically ❑ <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 I I procedure <br /> ❑ 12. 1 Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES <br /> ® 13. Bloodborne Pathogen training El ❑ 31. Areas separated/no living or sleeping quarters El <br /> Source: Cathie Montie ❑ 32. Floors and walls clean and in good repair,adequate light 13❑ 14. Appropriate personal protective equipment available and El El 33. Workstation,surfaces,including chairs,armrests,etc. in E]used good repair <br /> CUSTOMERSICLIENTS ❑ 34. Perm it/registration posted ❑ <br /> Branding is completed with no other customers in <br /> ❑ 15. rocedure area El ® 35. Operation and employee training records present E]F116. Customers eighteen(18)years of age or older ❑ COMPLIANCE AND ENFORCEMENT <br /> ❑ 17. Skin adequately prepared for procedure ❑ ® 36. Plan(s)submitted for review El <br /> Client records approved and available-Consent form <br /> ® 18. and uestionnaire ❑ El 37. Permits obtained and available E] <br /> ® 19. Appropriate aftercare instructions given to client ❑ rE:11 <br /> 38. Impoundment El <br /> MACHINE SAFETY AND SANITATION 39. Hearing scheduled 1:1❑ 20. Safe machine design ❑ 40. Closure ❑ <br /> ❑ 21. Machines cleaned and disinfected between clients ❑ ❑ 41. ❑ <br /> Received b (Print): Gustavo Hurtado Received b (Signature): � Phone: 209 546-2739 <br /> Specialist(Print): Harprit Mattu,Sr REHS Specialist(Signature): Phone: 209 468-3284 <br /> Reinspecion on/about: L A reinspection fee ofjdaS er hour may be charged. Page 1 of 2 <br /> EH-03/2015 9 15 Z <br />