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SAN J O AHQ I I N Environmental Health Department <br /> C: OUN1I Y11 <br /> Body Art Inspection Report <br /> Facility Name: Date: <br /> XOCHICALCO TATTOOS & COSMETICS August 20, 2021 <br /> Facility Address: Facility Phone: Program Record: <br /> 5308 PACIFIC AVE, STOCKTON, CA 95207 (209) 808-6139 PRO544021 <br /> Permit Holder: Permit Expiration Date: <br /> RIVERA, GERARDO & ROSAS, YECENIA June 30, 2022 <br /> Inspection Type: Program: <br /> ROUTINE INSPECTION - Operating Permit 4120 - BODY ART FACILITY-SINGLE USE <br /> The above facility is inspected for compliance with Division 104, Part 15, Chapter 7 of the California Health and Safety Code (HSC). <br /> V = Violation COS = Corrected on site <br /> Cleaning and Sterilization <br /> 1 HSC 119315(b) Autoclave: approved and effective - passed integrator test OV o COS <br /> 2 HSC 119309, Items washed, disinfected, packaged, labeled, and sterilized QV o COS <br /> 119315(a) <br /> 3 HSC 119315(b) Autoclave loaded correctly/packages allowed to dry QV O COS <br /> 4 HSC 119315(b) Integrators used/monthly spore test/log maintained 0V o COS <br /> 5 HSC 119314(c) Decontamination/sanitation area separated and supplied appropriately 0V o COS <br /> 6 HSC 119315(f) Invoices and log kept for disposable, pre-sterilized equipment • V D COS <br /> 7 HSC 119314(e) Sharps containers labeled, used, and disposed of appropriately OV D COS <br /> 8 HSC 119310 Jewelry, tattoo and piercing equipment - clean and sterilized OV n COS <br /> Practitioner Health and Hygiene <br /> 9 HSC 119309 No eating, drinking or smoking - clean clothes 0V D COS <br /> 10 HSC 119308(a) Hands washed effectively and timely o V O COS <br /> 11 HSC 119314(b) Handwashing facilities properly supplied and accessible, warm water 0V O COS <br /> 12 HSC 119306(c) Hepatitis B vaccination D V O COS <br /> 13 HSC 119307 Bloodborne Pathogen training D V D COS <br /> 14 HSC 119308(a) Appropriate personal protective equipment available and used 0V (I COS <br /> Customers/Clients <br /> 15 HSC 1193096) Branding is completed with no other customers in procedure area D v D COS <br /> 16 HSC 119302 Customers eighteen (18) years of age or older D V D COS <br /> 17 HSG 119308(a) Skin adequately prepared for procedure o V D COS <br /> 18 HSC 119303 Client records approved and available - Consent form and questionnaire o V D COS <br /> 19 HSC 119308(b) Appropriate aftercare instructions given to client 0V D COS <br /> Machine Safety and Sanitation <br /> 20 HSC 119311 (i) Safe machine design OV D COS <br /> 21 HSC 119311 (h) Machines cleaned and disinfected between clients OV D COS <br /> 22 HSC 119311 (g) Parts replaced between clients - grommets, elastic bands, etc. D V D COS <br /> Preventing Cross Contamination <br /> 23 HSC 119309 Workstation/procedure area decontaminated OV D COS <br /> 24 HSC 119301 (k) Appropriate chemical disinfectant used n V D COS <br /> 25 HSC 119309(b) Disinfectant used appropriately/sufficient contact time D V O COS <br /> FA0025033 PR0544021 SCO01 OB/20/2021 <br /> EHD Rev. 6/15/2021 Page 1 of Body Ad OR <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br />