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A4 ' Body Ins eA Report Y Art p p Date: <br /> (? {il San Joaquin County Environmental Health Department Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: S j?Qd �96a <br /> c c// (209)468-3420 Program <br /> www.sioay.orp/ehd Element: 103 <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 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 /> <�. ;: <br /> CLEANING AND STERI1=17ATIOh1. :' C ' Y. M,i4HINE SAFETY AIVD SANLIATION <br /> ❑ 1 Autoclave:approved and effective-passed integrator ❑ ❑ 22. Parts replaced between clients-grommets,elastic bands, E]testetc. <br /> Items washed,disinfected, packaged, labeled,and <br /> F-12. sterilized EIPREYENTINCi GROSS.CONTAIV[jNATION <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 <br /> El 5. ElChemical used: Cavicide <br /> aro riatel <br /> Invoices and log kept for disposable, pre-sterilized <br /> ® 6. ❑ El 25. Disinfectant used appropriately/sufficient contact time <br /> equipment <br /> ElSharps containers labeled, used,and disposed of <br /> ® 7' ElWet contact time provided: 2 min <br /> a ro riatel <br /> Jewelry,tattoo and piercing equipment-clean and <br /> FI 8. El El 26. Barriers used <br /> sterilized <br /> ' ❑ 27 Products applied to skin are single use/dispensed ❑ <br /> PiCTITIONER HEALTH ANDHYGIENE Y, t .y 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 11. warm water El ❑ 30. procedure El <br /> El <. W,` <br /> ❑ 12. Hepatitis B vaccination <br /> 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 /> ❑ <br /> Appropriate personal protective equipment available and Workstation, surfaces, including chairs, armrests,etc. in 14. used El ® 33. good repair El <br /> ❑ 34. Permit/re istration posted ❑ <br /> ;;CUSTOMERS/CL[ENTS ,;; ,� .,, g <br /> ❑ <br /> Branding is completed with no other customers in 15. El E]® 35. Operation and employee training records present <br /> procedure area <br /> tea, <br /> ❑ 16. Customers eighteen(18)years of age or older ❑ <br /> COMPLIANCE A �?ENFE?RGEMENT <br /> ❑ 17. Skin adequately prepared for procedure ❑ ❑ 36. Plan(s)submitted for review ❑ <br /> ® <br /> Client records approved and available-Consent form ❑18. El 37. Permits obtained and available <br /> and questionnaire <br /> ❑ 19. Appropriate aftercare instructions given to client ❑ ❑ 38. Impoundment ❑ <br /> MAHINE.3AF,ETY AN©:SANITATION El 39. Hearing scheduled ❑ <br /> ❑ 20. Safe machine design ❑ ❑ 40. Closure ❑ <br /> ❑ 21. Machines cleaned and disinfected between clients ❑ ❑ 41. ❑ <br /> Received b (Print): Gerardo Rivera Received by(Signature): Phone: 209 643-9947 <br /> Specialist(Print): Navjot Sahota Specialist(Signature): Phone:(209)468-3178 <br /> Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Page 1 of 2 <br /> EH-11/17 <br />