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2 <br /> Body Art Inspect Report • Date: iA'I t <br /> San Joaquin County Environmental Health Department Program <br /> S tz o0�8 q� <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: 2 <br /> (209)468-3420 Program lb <br /> c4<")FaR� wWwsiogv.orq/ehd Element: <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 Initial 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 ❑ ❑ 22 Parts replaced between clients-grommets,elastic bands, Eltest etc. <br /> ❑ <br /> Items washed,disinfected,packaged,labeled,and 2' sterilized E] PREVENTING CROSS-CONTAMINATION <br /> ❑ 3. Autoclave loaded correctly/packages allowed to dry ❑ ❑ 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 /> 5' appropriatelyElChemical used: Hepacide <br /> Invoices and log kept for disposable,pre-sterilized <br /> El 6' ❑ <br /> equipment E] 25. Disinfectant used appropriately/sufficient contact time <br /> F-1Sharps containers labeled,used,and disposed of <br /> ❑ 7' El [Wet contact time provided: 10 mins <br /> appropriately <br /> ❑ 8 Jewelry,tattoo and piercing equipment-clean and <br /> sterilized 1:1 El 26. Barriers used El <br /> Products applied to skin are single use/dispensed <br /> PRACTITIONER HEALTH AND HYGIENE FI 27. 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 /> Handwashing facilities properly supplied and accessible, Cross-contamination avoided during all phases of <br /> El 11. warm water El ❑ 30' procedure <br /> ❑ <br /> ❑ 12. Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES <br /> ❑ 13. Bloodborne Pathogen trainingElElEl31. Areas separated/no living or sleeping quarters <br /> Source: Cathie Montie ® 32. Floors and walls clean and in good repair,adequate light ❑ <br /> Appropriate personal protective equipment available and Workstation,surfaces,including chairs,armrests,etc. in <br /> ❑ 14. ❑used ® 33' good repair <br /> E] <br /> CUSTOMERS/CLIENTS ❑ 34. Perm it/registration posted ❑ <br /> Branding is completed with no other customers in <br /> El 15. rocedure area E] 1:135. Operation and employee training records present E] <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 /> iEl 37. Permits obtained and available Elanduestionnare <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 onlabout: A reinspection fee of$130 per hour may be charged. Page 1 of 2 <br /> EH-03/2015 <br />