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�IIIIfY Body Art Inspe%; uon Report Date : � �, San Joaquin County Environmental Health Department Program 1868 E . Hazelton Ave. , Stockton, CA 95205 1 , �r 06 (209) 468-3420 Record :O 9 K „Nc www. siogv. org/ehd Pro ram Element: Facility Name Address City Zip Code Flawlous 806 w lodi ave Lodi 95240 Name of Permit/Registration Holder Permit Exp, Date Time In Time Out Inspection Type Keli Degenstein 6/30/ 18 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 ❑ 1 Autoclave : approved and effective - passed integrator Parts replaced between clients - grommets , elastic bands , [ test El ❑ 22 ' etc. ❑ 2 Items washed , disinfected , packaged , labeled , and sterilized ❑ PREVENTING CROSS-CONTAMINATION ❑ 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 ❑ 51 Decontamination/sanitation area separated and supplied [ appropriately El Chemical used : Barbicide ❑ 6 Invoices and log kept for disposable , pre-sterilized equipment E] ❑ 25. Disinfectant used appropriately/sufficient contact time ❑ 7 Sharps containers labeled , used , and disposed of [ a ro riatel El Wet contact time provided : 1 min ❑ 8 Jewelry , tattoo and piercing equipment - clean and sterilized El El 26s Barriers used [ ❑ 27 Products applied to skin are single use/dispensed [ PRACTITIONER HEALTH AND HYGIENE aseptically ❑ 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 [ ❑ 11 . Handwashing facilities properly supplied and accessible , Cross-contamination avoided during all phases of [ warm water El ❑ 30 ' procedure ❑ 12 . Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES 0 . 13 . Bloodborne Pathogen training ❑ ❑ 31 . Areas separated/no living or sleeping quarters [ Source : Cathy Montle ❑ 32 . Floors and walls clean and in good repair, adequate light [ ❑ Appropriate personal protective equipment available and Workstation , surfaces, including chairs , armrests , etc. in 14. used El ❑ 33' ood repair [ CUSTOMERS/CLIENTS ❑ 34. Permit/registration posted [ Branding is completed with no other customers in El 15 . rocedure area El ® 35 . Operation and employee training records present [ ® 16 . Customers eighteen (18) years of age or older ❑ COMPLIANCE AND ENFORCEMENT ❑ 17. Skin adequately prepared for procedure ❑ ❑ 36. Plan (s) submitted for review [ ® Client records approved and available - Consent form 18 ' and questionnaire [:1 ❑ 37 . Permits obtained and available [ ❑ 19. Appropriate aftercare instructions given to client ❑ ❑ 38 . Impoundment [ MACHINE SAFETY AND SANITATION ❑ 39 . Hearing scheduled [ ❑ 20. Safe machine design ❑ ❑ 40 . Closure [ ❑ 21 . Machines cleaned and disinfected between clients ❑ ❑ 41 . [ Received b (Print) : Kell De enstein Received b (Signature) : Phone : 209 556-3281 Specialist (Print) : Nav'ot Sahota Specialist (Signature) : Phone : 209 468-3178 Reinspecion on/about: A reinspection fee of $152 per hour may be charged . Page 1 of EH- 11 / 17