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0p4U'IN Body Art InSpeCtiReport Date: <br /> San Joaquin County Environmental Health Department <br /> Program <br /> 70 <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: -PROS-Nn.Sn <br /> c ,P (209)468-3420 <br /> Program <br /> q<�FOR�a` www.siogv.org/ehd g <br /> Element: '4120 <br /> Facility Name Address City Zip Code <br /> Visual Changes 445 w weber ave suite 124b Stockton 95203 <br /> Name of Permit/Registration Holder Permit Exp. Date Time In Time Out Inspection Type <br /> Hynek Washington 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, Eltest etc. <br /> ❑ <br /> Items washed,disinfected,packaged, labeled,and 2. sterilized El 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 ❑ <br /> ❑ 5. appropriately ❑ Chemical used: <br /> ® <br /> Invoices and log kept for disposable,pre-sterilized 6. equipment ❑ [_125. Disinfectant used appropriately/sufficient contact time <br /> Sharps containers labeled, used,and disposed of ❑ <br /> ❑ 7' E]appropriately <br /> [Wet contact time provided: <br /> ❑ <br /> Jewelry,tattoo and piercing equipment-clean and 8' ❑ ❑ 26. Barriers used <br /> sterilized ❑ <br /> Products applied to skin are single use/dispensed <br /> PRACTITIONER HEALTH AND HYGIENE El 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 /> ❑ 11. warm water ❑ ❑ 30' procedure <br /> El <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 /> Appropriate personal protective equipment available and Workstation,surfaces, including chairs,armrests,etc. in <br /> F] 14. Elused rEE11 <br /> 33. ood repair ❑ <br /> CUSTOMERS/CLIENTS 34. Permit/registration posted ElBranding is completed with no other customers inEl15. rocedure area El 35. 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 /> ® <br /> Client records approved and available-Consent form 18. El El37. Permits obtained and available Elandquestionnaire <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): H nek Washington Received by(Signature): I L,wv, one:209-518-0518 <br /> Specialist(Print): Sandip Singh Specialist(Signature): Phone: 209-468-3526 <br /> Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Page 1 of 2 <br /> EH-11/17 <br />