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Body Art Inspecti&eport Date: <br /> San Joaquin County Environmental Health Department <br /> Program <br /> Yi 1868 E.Hazelton Ave.,Stockton,CA 95205 g PROSK l 6S b <br /> p (209)468-3420 Record: U <br /> Program <br /> ogI110 <br /> Element: <br /> Facility Name Address City Zip Code <br /> Flawlous 806 w Jodi ave Lodi 95240 <br /> Name of Permit/Registration Holder Permit Exp. Date Time In Time Out Inspection Type <br /> Keli Degenstein 6/30/19 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, F1test etc. <br /> Items washed,disinfected,packaged,labeled,and <br /> El 2' sterilized El CROSS-CONTAMINATION <br /> ❑ 3. Autoclave loaded correctly/packages allowed to dry [:1 ❑ 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 El <br /> El 5. a ro riatel ❑ Chemical used: Barbicide,Caviwipes <br /> Invoices and log kept for disposable,pre-sterilized <br /> ® 6. equipment ❑ ❑ 25. Disinfectant used appropriately/sufficient contact time <br /> ElSharps containers labeled,used,and disposed of <br /> ❑ 7 Ela ro riatel Wet contact time provided: 3 mins,3 mins <br /> Jewelry,tattoo and piercing equipment-clean and <br /> El 8. El 26. Barriers used E]sterilized <br /> Products applied to skin are single use/dispensed <br /> PRACTITIONER HEALTH AND HYGIENE El 27' asepticallyE] <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 /> Handwashing facilities properly supplied and accessible,❑ Cross-contamination avoided during all phases of 11. warm water ❑ 30" procedure <br /> El <br /> ❑ 12. Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES <br /> ❑ 13. Bioodbome Pathogen training ❑ 31. Areas separated/no living or sleeping quarters ❑ <br /> Source: Biologix,Bloodborne Pathogen Training,Cathy ❑ <br /> ❑ <br /> Montie 32. Floors and walls clean and in good repair,adequate light ❑ <br /> ❑ <br /> Appropriate personal protective equipment available and Workstation,surfaces,including chairs,armrests,etc.in 14. used El ® 33' goo repair <br /> ❑ <br /> CUSTOMERS/CLIENTS ❑ 34. Permittregistration posted ❑ <br /> ❑ <br /> Branding is completed with no other customers in 15. rocedure area El ® 35. 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-Consent form <br /> El F1El 18. 37. Permits obtained and available <br /> and questionnaire ❑ <br /> ❑1 19. 1 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 ❑ rE] 1 41. ❑ <br /> Received b (Print): Keli Degenstein Received by(Signature): Phone: 209 556-3281 <br /> Specialist(Print): Mai Vue Specialist(Signature): Phone: 209 468-3284 <br /> Reinspecion onlabout: A reinspection fee of$152 per hour may be charged. Page 1 of 2 <br /> EH-11/17 <br />