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Body Art Inspection Report Date(MM/DDNY) <br /> y County of San Joaquin County,Environmental Health Department <br /> w < 1868 E.Hazelton Ave.,Stockton CA 95205 Permit Number <br /> (209)468-3420 www.sioov.om1ehd <br /> ;.�y. Permit Type <br /> Facility Name11 Address 11 City Zip Code CT <br /> OMS :��1°PP Alb C 41y _ (�� '-TT&L4.1 q.15314, 'L 'Ary,� i.I YL <br /> Permit/Registration Holder Name ermit Exp.Date Total Time Inspection ype <br /> RISK FACTORS AND INTERVENTIONS <br /> Risk factors are improper practices or procedures identified as contributing factors of cross-contamination. <br /> Interventions are control measures to prevent cross-contamination and transfer of pathogens from one person to another. <br /> In=In Compliance Out=Not in Compliance N/O=Not Observed N/A=Not Applicable COS=Corrected On Site <br /> , h TATTOO AND PERMANENT COSMETICS MACHINE° <br /> CLEANINGAND STERILIZATION our cos SAFETY AND SANITATION our cos <br /> In N/0 1. Autoclave is approved and effective-passed In /0 18. Safe machine design 11 <br /> int rator test N/A <br /> In 2. Process of cleaning,labeling,packaging and /0 19. Machines cleaned and disinfected between <br /> 1 <br /> stertiziIng items correct) A clients <br /> In 3. Autoclave loaded correctly/packages allowed to 11 /0 20, Parts replaced between clients-grommets, <br /> 1 d /A elastic bands,etc. <br /> In 4. Integrators used/monthly spore test/log 11 13 PREVENTING GROSS-CONTAMINATION <br /> !A maintained <br /> In WO 5. Decontaminationlsanitation area separate and 11 ❑ In 1 21. Workstation/procedure area decontaminated O 17 <br /> supplied <br /> n N10 6. Invoices and log kept for disposable,pre- /0 22. Chemical disinfectant used e,ry` 0 I7 <br /> -N/A sterilized equipment,backu supplies available* 0 11 /A Chemical used:6qx 6e <br /> 0I N/O 7. Sharps containers supplied,labeled,used and In / 23. Disinfectant used sufficient contact time Wet <br /> NIA disposed of correct) * t7 0 IA contact timeprovided: 0 0 <br /> In10 8. Jewelry,tattoo and piercing equipment-storage n 10 24. Barriers available and used as part of <br /> IQI, and use procedure <br /> N/O 25. Products applied to skin are single <br /> U El <br /> PRACTITIONER HEALTH AND HYGIENE ' IA useldis ensed aseptically <br /> In N / 9. No eating,drinking or smoking-clean clothes 11 0 NATO 26. Storage of inks,pigments,needles,tubes,etc., <br /> In 10 10. Hands washed effectively and timely n NJO 27. Jewelry,Inks,Needles etc approved and used <br /> N/A NIA <br /> In NIO 11. Handwashing facilities properly supplied and Did 11 In 28. Cross-contamination avoided during all phases 0 <br /> NIA I accessible,warm potable water* N of procedure <br /> N/O 12. Personal protective equipment available and eEST'BI'SI SSS l RACTICES <br /> /A used,eyewash station available <br /> CIISTOMERSI6LIENTS In NO 29. Areas separated/no living or sleeping <br /> IAquarters/no animals <br /> In 13. Branding is completed with no other customers in In 0 30. Floors and walls clean and in good repair, <br /> Jprocedure area NIA adequate light <br /> n N10 14. Customers eighteen(18)years of age or older In N/O 31. Workstation,surfaces,including chairs,,etc.in <br /> \-411A NIA good repair;trash removed frequently* <br /> In NIO 15. Skin prepared for procedure, In N/O 32, Perm ittregistration and required signs posted <br /> N/A A <br /> In N/O 16. Client records available-Consent form& 13 UIAA <br /> /0 33. IPCP and employee training records and 0 0 <br /> NIA questionnaire He atitiis B vaccination status present <br /> In NIO 17. Aftercare instructions given to client In N/0 34 Restrooms available,stocked <br /> NIA NIA <br /> Received by(Print): Received by(Signature): Phone: <br /> Specialist(Printl: Specialist(Signature): Phone: y&r­y, , <br /> F1This report is an Official Notice of Violation.Corrections must be completed in the time sp cified. <br /> A reinspection fee may be charged if violations noted on this report are not corrected by the reinspection date. Reinspection Date(on or about) <br /> Page 2of- <br />