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Body Art Inspect Report • Date: <br /> N= San Joaquin County Environmental Health Department Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: Pr`u�L� <br /> b` (209)468-3420 <br /> c°<�F6 il� www.siogv.org/ehd Program Element: <br /> i I l L) <br /> Element: "' L <br /> Facility Name Address City Zip Code <br /> Xochicalco Tattoo&Cosmetics 5308 pacific ave suite 20 Stockton 95207 <br /> Name of Permit/Registration Holder Permit Exp. Date Time In Time Out Inspection Type <br /> Gerardo Rivera&Yecenia Rosas 6/30/20 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 E] ❑ 7Parts;replaced between clients-grommets,elastic bands, El <br /> etc. <br /> ❑ 2 Items washed,disinfected,packaged,labeled,and <br /> sterilized E] PREVENTING CROSS-CONTAMINATfON <br /> ❑ 3. Autoclave loaded correctly/packages allowed to dry ❑ ❑ 23. Workstation/procedure area decontaminated ❑ <br /> ❑ 4. Integrators used/monthly spore test/log maintained ❑ [1 24. Appropriate chemical disinfectant used <br /> ❑ 5 Decontamination/sanitation area separated and supplied Elappropriately <br /> El Chemical used: <br /> ® 6 Invoices and log kept for disposable,pre-sterilized <br /> equipment El El25. Disinfectant used appropriately/sufficient contact time <br /> ❑ 7 Sharps containers labeled,used,and disposed of ❑ <br /> ❑ Wet contact time provided: <br /> appropriately <br /> ❑ 8 Jewelry,tattoo and piercing equipment-clean and <br /> 11 El 26. Barriers used E]sterilized <br /> ❑ 27 Products applied to skin are single use/dispensed ElPRACTITIONER 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 El El 30" El procedure <br /> ❑ 12. Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES <br /> ® 13. Bloodborne Pathogen training ❑ ❑ 31. Areas separated/no living or sleeping quarters ❑ <br /> Source: ❑ 32. Floors and walls clean and in good repair,adequate light ❑ <br /> ❑ 14. Appropriate personal protective equipment available and Workstation,surfaces,including chairs,armrests,etc.in E3used El ❑ 33. good repair <br /> CUSTOMERS/CLIENTS ® 34. Perm ittregistration posted ❑ <br /> ❑ 15. Branding is completed with no other customers in <br /> rocedure area ❑ ® 35. Operation and employee training records present ❑ <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 /> El El 37. Permits obtained and available <br /> and questionnaire <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): Yecenia Rosas Received by(Signature): Phone:(209)643-9947 <br /> Specialist(Print): Mai Vue Specialist(Signature): Phone: 209 468-3284 <br /> Reinspeclon on/about: A reinspection fee of$152 per hour may be charged. Page 1 of 3 <br /> EH-11/17 <br />