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} <br /> °U'" Body Art Insietion Report Date: <br /> �Z San Joaquin County Environmental Health Department <br /> N` µ 1868 E.Hazelton Ave.,Stockton,CA 95205 Program �2 Z Q <br /> (209)468-3420 Record: fQ 0130 V <br /> www.siogv.org/ehd Program l� '03 <br /> Element: 1 <br /> Facility Name Address City Zip Code <br /> One Time Tattoo Studio 1818 luceme avenue Stockton 95205 <br /> Name of Permit/Registration Holder Permit Exp.Date Time In Time Out Inspection Type <br /> Emmanuel Maldonado Consultation <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 I 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, E]test etc. <br /> ❑ 2 Items washed,disinfected,packaged,labeled,and <br /> sterilized 11PREVENTING CROSS-CONTAMINATION <br /> ❑ 3. Autodave 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 /> ❑ <br /> 5. <br /> Decontamination/sanitation area separated and supplied El <br /> a ropriate El Chemical used: Madacide <br /> ® 6 Invoices and log kept for disposable,pre-sterilized <br /> ui ment E] ® 25. Disinfectant used appropriately/sufficient contact time <br /> ® 7 Sharps containers labeled,used,and disposed of Ela <br /> appropriately El Wet contact time provided: <br /> ❑ 8 Jewelry,tattoo and piercing equipment-clean and <br /> sterilized 1:1 El26. Barriers used E] <br /> ❑ 27 Products applied to skin are single use/dispensed ❑ <br /> PRACTITIONER 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, ❑ ❑ 30. Cross-contamination avoided during all phases of ❑ <br /> warm waterprocedure <br /> ❑ 12. Hepatitis B vaccination ❑ <br /> BEST BUSINESS PRACTICES <br /> ❑ 13. Bloodbome Pathogen trainingE] ❑ 31. Areas separated/no living or sleeping quarters ❑ <br /> Source: Cathy Montie ® 32. Floors and walls clean and in good repair,adequate light ❑ <br /> ❑ 14 Appropriate personal protective equipment available and ❑ ® 33 Workstation,surfaces,including chairs,armrests,etc.in <br /> used good repair <br /> CUSTOMERS/CLIENTS ® 34. Permittregistration posted ❑ <br /> ❑ 15. Branding is completed with no other customers in <br /> procedure area El ® 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 r-1and questionnaire [jEl37. Permits obtained and available <br /> ❑ 19. Appropriate aftercare instructions given to client ❑ ❑ 38. Impoundment ❑ <br /> MACHINE SAFETY AND SANITA710M ❑ 39. Hearing scheduled ❑ <br /> ❑ 20. Safe machine design ❑ ❑ 40. Closure ❑ <br /> ❑ 21. Machines cleaned and disinfected between clients ❑ ❑ 41. ❑ <br /> Received b (Print): Emmanuel Maldonado Received b (Si nature): Phone: 408 661-1295 <br /> Specialist(Print): Mai Vue Specialist(Signature): 0':%44WVLi Phone: (209)468-3284 <br /> Reinspecion onlabout: A reinspection fee of$152 per hour may be charged. Page 1 of 3 <br /> EH-11/17 <br />