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o q Body Art Inspection Report Date(MM/DD/YY) I Q L- )7� y County of San Joaquin County,Environmental Health Department w <� 1868 E.Hazelton Ave.,Stockton CA 95205 Permit Number (209)468-3420 www.sigov.org/ehd Permit Type Facility Name Address City Zip Code CT `AJC_ )'rr"4 -/ l'i37f• V-1 ,('YtGn :.A PermitlRegistration Holder Name Permit Exp.Date Total Time Inspection Type Gov 12a4 A rt_-fY)1.r- RISK FACTORS AND INTERVENTIONS Risk factors are improper practices or procedures identified as contributing factors of cross-contamination. Interventions are control measures to prevent cross-contamination and transfer of pathogens from one person to another. In=In Compliance Out=Not in Compliance N/O=Not Observed NIA=Not Applicable COS=Corrected On Site TATTOO AND PERMANENT COSMETICS MACHINE �� :._ CLEANING ANO STERILIZATION. ,. oirr cos SAFETY AND SANITATION OUT Cos In /0 1. Autoclave is approved and effective-passed I NIO 18. Safe machine design integrator test IA In N10 2. Process of cleaning,labeling,packaging and In NIO 19. Machines cleaned and disinfected between 0 NIA stedizjing items correctly NIA clients In AO 3. Autoclave loaded correctly/packages allowed to CI 13 In 0 20. Parts replaced between clients-grommets, 0 El lA dry qml elastic bands,etc. In 10 4. Integrators used/monthly spore test/log 0 11 PREVENTING GROSS-CONTAMINATION maintained In 0 5. Decontamination/sanitation area separate and 0 El In21. Workstation/procedure area decontaminated 13 0 NI supplied* N / In NIO 6. Invoices and log kept for disposable,pre- 11 Co N/0 22. Chemical disinfectant used 11 11 N/A sterilized equipment,backu supplies available* 01� NI Chemical used. I -e- t�L In N/0 7. Sharps containers supplied,labeled,used and 0 13 In K 23. Disinfectant used sufficient contact time Wet 11 11 /A disposed of correct) * I contact timeprovided: NIO 8. Jewelry,tattoo and piercing equipment-storage NIO 24. Barriers available and used as part of El 0 NIA and use N/A rocedure* N/0 25. Products applied to skin are single PRACTITIONER HEALTH AND HYGIENE N/A use/dispensed aseptically n N10 9. No eating,drinking or smoking-clean clothes 0 N/0 26. Storage of inks,pigments,needles,tubes,etc., N/A NIA In 10. Hands washed effectively and timely 11 El I N/0 27. Jewelry,Inks,Needles etc approved and used NIA In NIO 11. Handwashing facilities properly supplied and p E3 10 NIO 28. Cross-contamination avoided during all phases 0 N1A accessible,warm potable water* NIA of procedure In N10 12. Personal protective equipment available and BEST BUSINESS PRACTICES' NIA used,a awash station available CUSTOMERSICLIENTS I NIO 29. Areas separated/no living or sleeping �, )A; NIAquarters/no animals In,WO 13. Branding is completed with no other customers in ❑ 1 In NIO 30. Floors and walls clean and in good repair, N/ procedure area N/A adequate liht* UN/0 14. Customers eighteen(18)years of age or older n 13 In N/0 31. Workstation,surfaces,including chairs,,etc.in N/A NIA good repair,trash removed frequently* N/0 15. Skin prepared for procedure. 0 0 In NIO 32. Permit/registration and required signs posted* 0 El NIA N/A In N/O 16. Client records available-Consent form& D6-- 13 In N/O 33. IPCP and employee training records and El NIA questionnaire N/A He atitiis B vaccination status present In N10 17. Aftercare instructions given to client 17 In N/0 34 Restrooms available,stocked* ❑ NIA NIA fry: Received b (Print): ` Received b (Signature): Phone: Specialist(Print): A 6t,it, Specialist(Signature): Phone: �rr%�` 713 r] This report is an Official Notice of Violation.Corrections must be completed in the time sp ified. A reinspection fee may be charged if violations noted on this report are not corrected by the reinspection date. Reinspection Date(on or about) Page I of_