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Rev PSD <br /> Body Art Insotion Report Date: �a hI <br /> San Joaquin County Environmental Health Department Program <br /> j186 E.Hazelton Ave.,Stockton,CA 95205 Record: PRO 5,44 0 5O <br /> (209)468-3420 Program <br /> www.siogv.org/ehd Element: N I eZ 0 <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 /> ❑ 1 Autoclave:approved and effective-passed integrator ❑ ❑ 22 Parts replaced between clients-grommets,elastic bands, ❑ <br /> test etc. <br /> Items washed,disinfected,packaged, labeled,and <br /> ❑ 2. sterilized ❑ _; <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 /> ElDecontamination/sanitation area separated and supplied <br /> El 5' ❑ Chemical used: <br /> a ro riatel <br /> ® <br /> Invoices and log kept for disposable, pre-sterilized 6• El El25. Disinfectant used appropriately/sufficient contact time <br /> equipment <br /> Sharps containers labeled, used,and disposed of ❑ <br /> ® 7' ElWet contact time provided: <br /> a ro riatel <br /> Jewelry,tattoo and piercing equipment-clean and <br /> El 8. El El26. Barriers used ❑ <br /> sterilized <br /> Products applied to skin are single use/dispensed <br /> ❑ 27. El <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 El ❑ 30. procedure <br /> El <br /> ❑ 12. Hepatitis B vaccination ❑ <br /> p <br /> ® 13. Bloodborne Pathogen training ❑ [j 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 /> El 14. ❑used ® 33. good repair <br /> El <br /> JW ❑ 34. Permit/registration posted ❑ <br /> ❑ <br /> Branding is completed with no other customers in 15. El E]® 35. Operation and employee training records present <br /> procedure area <br /> M r4 <br /> ❑ 16. Customers eighteen(18)years of age or older ❑ <br /> ❑ 17. Skin adequately prepared for procedure ❑ ❑ 36. Plan(s)submitted for review ❑ <br /> Client records approved and available-Consent form <br /> ® 18. El [137. Permits obtained and available Eland questionnaire <br /> ❑ 19. Appropriate aftercare instructions given to client ❑ ❑ 38. Impoundment ❑ <br /> ❑ 39. Hearing scheduled ❑ <br /> ❑ 20. Safe machine design ❑ ❑ 40. Closure ❑ <br /> ❑ 21. Machines cleaned and disinfected between clients ❑ rEIT41.T ❑ <br /> Received b (Print): H nek Washington Received by(Signature): t Phone: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 3 <br /> EH-11/17 <br />