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i <br /> Body Art Inspect _ n Report <br /> a � aLl IlDate : <br /> P 41- <br /> San Joaquin County Environmental Health Department <br /> Program <br /> Is ' 1868 E. Hazelton Ave. , Stockton, CA 95205 �,DI <br /> S <br /> Record : <br /> su <br /> (209) 468-3420b ' Program 4 I LO <br /> {�j` www. siogv. org/ehd Element: <br /> Facility Name Address City Zip Code <br /> Flawlous 806 w, lodi ave . Lodi 95240 <br /> Name of Permit/Registration Holder Permit Exp , Date Time In Time Out Inspection Type <br /> Keli Degenstein 6/30/17 Fnl Con/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 Parts replaced between clients - grommets, elastic bands , <br /> test El 22 ' etcEl. <br /> ❑ 2 Items washed , disinfected , packaged , labeled , and <br /> sterilized El CROSS-CONTAMINATION <br /> ❑ 3 . Autoclave loaded correctly/packages allowed to dry rn <br /> El 23 , Workstation/procedure area decontaminated El <br /> ❑ 4. Integrators used/monthly spore test/log maintained ❑ 24. Appropriate chemical disinfectant used <br /> El 5, Decontamination/sanitation area separated and supplied Elaro <br /> appropriately Chemical used : <br /> ❑ 6 Invoices and log kept for disposable , pre-sterilized <br /> equipment El El 25 , Disinfectant used appropriately/sufficient contact time <br /> ❑ <br /> El appropriately El Wet contact time provided : <br /> Sharps containers labeled , used , and disposed of <br /> ❑ 8 Jewelry , tattoo and piercing equipment - clean and <br /> El 26. Barriers used Elsterilized <br /> ❑ 27 Products applied to skin are single use/dispensed ElPRACTITIONER HEALTH AND HYGIENE 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, Cross-contamination avoided during all phases of <br /> warm water El ❑ 30 El <br /> ❑ 12 . Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES <br /> ❑ 13 . Bloodborne Pathogen trainingElEl31 . Areas separated/no living or sleeping quarters ❑ <br /> Source : ❑ 32. Floors and walls clean and in good repair, adequate light ❑ <br /> El 146 Appropriate personal protective equipment available and Workstation , surfaces , including chairs , armrests , etc. in ❑ <br /> used El ❑ 33' good repair <br /> CUSTOMERS/CLIENTS ❑ 34. Permit/registration posted ❑ <br /> ❑ <br /> Branding is completed with no other customers in 15. rocedure area ❑ El35 . Operation and employee training records present El <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 /> Client records approved and available I, Consent form <br /> El 18 . questionnaire <br /> El 37. Permits obtained and available Eland <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 ❑ ❑ 41 . ❑ <br /> Received b (Print) : Keli De enstein Received by (Signature) : Phone : 209 556-3281 <br /> Specialist (Print) : Benjamin Escotto , Sr REHS Specialist (Signature) : ' Phone : 209 468-3178 <br /> Reinspecion on/about: A reinspection fee of $ 130 per hour may be charged . Page 1 of 2 <br /> EH-03/2015 <br />