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i <br /> ,cot Body Art Inspects Report Date: <br /> J b12W A ' <br /> San Joaquin County Environmental Health Department Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205Record: S'R O O 7 s Z 9 7 <br /> (209)468-3420 <br /> c4<1FFoR`'�P www.siogv.org/ehd Program 1 O 7- <br /> Element: 1 <br /> Facility Name Address City Zip Code <br /> The Freckled Rose 1110 w.kettleman In.ste 20b Lodi 95240 <br /> Name of Permit/Registration Holder Permit Exp.Date Time In Time Out Inspection Type <br /> Daniel Bryant Final Consult. <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, Eltest ❑ ❑ 22' etc. <br /> ❑ 2 Items washed,disinfected,packaged,labeled,and <br /> sterilized El CROSS-CONTAMINATION <br /> ❑ 3. Autoclave loaded correctly/packages allowed to dry [:1 [:1 23. Workstation/procedure area decontaminated ❑ <br /> ❑ 4. Integrators used/monthly spore test/log maintained ❑ ❑ 24. Appropriate chemical disinfectant used <br /> ❑ 5 Decontamination/sanitation area separated and supplied ❑ <br /> ElChemical used: Hepacide <br /> -appropriately <br /> ❑ 6 Invoices and log kept for disposable,pre-sterilized <br /> equipment El El25. Disinfectant used appropriately/sufficient contact time <br /> Sharps containers labeled,used,and disposed of ❑ <br /> ❑ 7' E]appropriately Wet contact time provided: 10 mins <br /> Jewelry,tattoo and piercing equipment-clean and <br /> El 8. El El 26. Barriers used E]sterilized <br /> ❑ 27 Products applied to skin are single use/dispensed ❑ <br /> PRACTITIONER 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 13 ❑ 30E]. procedure <br /> ❑ 12. Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES <br /> ❑ 13. Bloodborne Pathogen training ❑ ❑ 31. Areas separated/no living or sleeping quarters ❑ <br /> Source: Cathie Montie ® 32. Floors and walls clean and in good repair,adequate light ❑ <br /> ❑ 14. Appropriate personal protective equipment available and ❑ ® 33 Workstation,surfaces,including chairs,armrests,etc.in Elused good repair <br /> CUSTOMERSICLIENTS ❑ 1 34. Perm it/registration posted ❑ <br /> ❑ 15. Branding is completed with no other customers in <br /> ❑ ❑ 35. Operation and employee training records present Elrocedure area <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 /> ® 18 Client records approved and available-Consent form <br /> questionnaire <br /> El El 37. Permits obtained and available <br /> and ❑ <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): Daniel Bryant Received by(Signature): Phone: 209 366-4841 <br /> Specialist(Print): Har rit Mattu,Sr REHS Specialist(Signature): Phone: 209 468-3284 <br /> Reinspecion on/about: A reinspection fee of$130 per hour may be charged. Page 1 of 2 <br /> EH-03/2015 <br />