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Body Art Inspectieport Date: c / <br /> San Joaquin County Environmental Health Department Program <br /> ice 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: 1� <br /> C (209)468 3420 Program <br /> CI r=aw'` ., mnk5 ogv.orq/ehd Element: <br /> Facility Name Address City Zip Code <br /> Relax Hermosa 39 in sacramento street Lodi 95240 <br /> Name of Permit/Registration Holder Permit Exp.Date Time In Time Out Inspection Type <br /> Jessica Hernandez 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, ❑ <br /> test I etc. <br /> Items washed,disinfected,packaged,labeled,and <br /> ❑ 2" sterilized I PREVENTING CROSS-CONTAMINATION <br /> ❑ 3. Autoclave loaded correctly/packages allowed to dry ❑ ❑ 23. Workstation/procedure area decontaminated 1-1❑ 4. Integrators used/monthly spore test/log maintained ❑ El 24. Appropriate chemical disinfectant used <br /> El 5. Decontamination/sanitation area separated and supplied ❑ Chemical used: Cavi Wipes,Cavi Spray,Barbicide El appropriately <br /> Invoices and log kept for disposable,pre-sterilized <br /> ❑ 6" El El25. Disinfectant used appropriately/sufficient contact time <br /> a uipment <br /> ❑ 7 Sharps containers labeled,used,and disposed of ❑ Wet contact time provided: 3 mins, 1 min, 10 mins <br /> appropriately <br /> Jewelry,tattoo and piercing equipment-clean and <br /> F1 8' E] ❑ 26. Barriers used <br /> sterilized ❑ <br /> Products applied to skin are single use/dispensed <br /> PRACTITIONER HEALTH AND HYGIENE ® 27. asepticallyEJ <br /> ❑ 9. No eating,drinking or smoking-clean clothes ❑ ❑ 28. Storage of inks,pigments,needles,tubes,etc. ❑ <br /> ❑ 10. Hands washed effectively and timely ❑ [129. Jewelry, Inks,Needles etc approved and used correctly El <br /> ❑ 11 Handwashing facilities properly supplied and accessible, ❑ ❑ 30 Cross-contamination avoided during all phases of E]warm waterprocedure <br /> F112. Hepatitis B vaccination [Ell BEST BUSINESS PRACTICES <br /> ® 13. Bloodborne Pathogen training ❑ ❑ 31. Areas separated/no living or sleeping quarters ❑ <br /> Source: Above Training and Body Art Training Group ❑ 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 <br /> used good repair <br /> CUSTOMERS/CLIENTS ® 34. Perm it/registration posted ❑ <br /> Branding is completed with no other customers in <br /> El 15. El El 35. Operation and employee training records present <br /> procedure 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 /> Client records approved and available-Consent form <br /> ® 18. ❑ ❑ 37. Permits obtained and available Elanduestionnaire <br /> ❑ 19. Appropriate aftercare instructions given to client ❑ ❑ 38. Impoundment ❑ <br /> MACHINE SAFETY AND SANITATION ❑ 39. Hearing scheduled El <br /> ❑ 20. Safe machine design ❑ ❑ 40. Closure ❑ <br /> ❑ 21. Machines cleaned and disinfected between clients ❑ ❑ 41. ❑ <br /> Received b (Print): Jessica Hernandez Received b Si nature): Phone:(209)263-9881 <br /> Specialist(Print): Mai Vue Specialist(Signature)',-AA 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 />