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Body Art Inspoion Report ` Date: <br /> ' � San Joaquin County Environmental Health Department Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205New PF- <br /> (209) <br /> 468-3420 Record: <br /> P,� Program u <br /> 1Foaii� www.sjogv.org/ehd 1 I�u <br /> Element: <br /> Facility Name Address City Zip Code <br /> One Time Tattoo Studio 1818 lucerne avenue Stockton 95205 <br /> Name of Perm it/Registration Holder Permit Exp.Date Time In Time Out Inspection Type <br /> Emmanuel Maldonado Final/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, ❑ <br /> test 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" ❑ Chemical used: Madacide <br /> appropriately <br /> & <br /> ro riatel <br /> ® <br /> Invoices and log kept for disposable,pre-sterilized 6" El 25. Disinfectant used appropriately/sufficient contact time <br /> equipment <br /> ElSharps containers labeled,used,and disposed of <br /> ❑ 7" Elappropriately <br /> [Wet contact time provided: <br /> ❑ <br /> Jewelry,tattoo and piercing equipment-clean and 8" ❑ ❑ 26. Barriers used E]sterilized <br /> Products applied to skin are single use/dispensed <br /> PRACTITIONER HEALTH AND HYGIENE ❑ 27" asepticallyr-1 <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 property supplied and accessible,❑ Cross-contamination avoided during all phases of 11. warm water El ❑ 30" procedure El <br /> ❑ 12. Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES <br /> ❑ 13. Bloodborne Pathogen training ❑ 31. Areas separated/no living or sleeping quarters ❑ <br /> El <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 /> CUSTOMERSICLIENTS ❑ 34. Permit/registration posted ❑ <br /> ❑ <br /> Branding is completed with no other customers in 15. ❑ ❑ 35. Operation and employee training records present Elrocedure area <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. and uestionnaire 1:1 ❑ 37. Permits obtained and available ❑ <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): Emmanuel Maldonado Received b (Signature): Phone: 408 661-1295 <br /> Specialist(Print): Mai Vue Specialist(Si nature: Phone: 209 468-3284 <br /> Reinspecion on/about: A reinspection fee of$152 per hour may be charged" Page 1 of 2 <br /> EH-11/17 <br />