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pPa•U 1 N.'�C � Body Art Inspection Report Date: March 22, 2023 a San Joaquin County Environmental Health Department Program g N Re.11 1868 E. Hazelton Ave., Stockton, CA 95205 Record: PR0540884 (209) 468-3420 'cq Program www.sFogv.org/ehd Element: 4120 F oR Facility Name Address City Zip Code Mudville Tat2 Studio 127 W Harding Way #A Stockton 95204 Name of Permit/Registration Holder Permit Exp. Date Time In Time Out Inspection Type Gustavo Hurtado 6/30/23 Routine The above facility is inspected for compliance with Division 104, Part 15, Chapter 7 of California Health and Safety Code (HSC). V = Violation C = Corrected On Site V CLEANING AND STERILIZATION C V MACHINE SAFETY AND SANITATION cont. C El1. Autoclave: approved and effective - passed integrator test El El22. Parts replaced between clients - grommets, elastic bands, etc. El El Items washed, disinfected, packaged, labeled, and sterilized ❑ PREVENTING CROSS-CONTAMINATION El 3. Autoclave loaded correctly/packages allowed to dry ❑ ❑ 23. Workstation/procedure area decontaminated ❑ ❑ 4. Integrators used/monthly spore test/log maintained ❑ ❑ 24. Appropriate chemical disinfectant used El 5' Deco ntamination/sanitation area separated and supplied ElChemical used: appropriately® 6. Invoices and log kept for disposable, pre-sterilized equipment ❑ ® 25. Disinfectant used appropriately/sufficient contact time El 7' Sharps containers labeled, used, and disposed of ElWet contact time provided: 5 appropriately❑ 8. Jewelry, tattoo and piercing equipment - clean and sterilized ❑ ❑ 26. Barriers used ❑ ❑ 27. Products applied to skin are single use/dispensed aseptically ❑ PRACTITIONER HEALTH AND HYGIENE ® 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 ❑ El 11. Handwashing facilities properly supplied and accessible, ❑ ❑ 30. Cross-contamination avoided during all phases of procedure Elwarm water ❑ 12. Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES 13. Bloodborne Pathogen training ❑ 31. Areas separated/no living or sleeping quarters ❑ ❑ ❑ Source: ® 32. Floors and walls clean and in good repair, adequate light ❑ ❑ 14. Appropriate personal protective equipment available and ❑ ® 33 Workstation, surfaces, including chairs, armrests, etc. in good ❑ used repair ® 34. Permit/registration posted ❑ CUSTOMERS/CLIENTS El 15. Branding is completed with no other customers in procedure ❑ ® 35. Operation and employee training records present ❑ area ❑ 16. Customers eighteen (18) years of age or older ❑ COMPLIANCE AND ENFORCEMENT ❑ 17. Skin adequately prepared for procedure ❑ ❑ 36. 1 Plan(,) submitted for review ❑ ® 18. Client records approved and available - Consent form and El El37. Permits obtained and available ❑ uestionnaire ❑ 19. Appropriate aftercare instructions given to client ❑ ❑ 38. Impoundment ❑ [1 39. Hearing scheduled ❑ MACHINE SAFETY AND SANITATION ❑ 20. Safe machine design ❑❑ 40. Closure ElEl21. Machines cleaned and disinfected between clients E] ❑ 41. ❑ Received by (Print): Gustavo Hurtado Received by (Signature): EMAILED Phone: 209-292-9429 Specialist (Print): Sandip Singh Specialist (Signature): Phone: 209-468-3526 Reinspection on/about: A reinspection fee of $156 per hour may be charged. Page 1 of 3 EH -11/17