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Body Art Inspection Report Date(MM/DD/YY) /P-02-13 y y County of San Joaquin County,Environmental Health Department 6$ a' c lass E.Hazelton Ave.,Stockton CA 95205 Permit Number PTOe2a (209)468-3420 www.sioov.om/ehd L ` - Permit Type Facility Name Address City Zip Code CT Tvv.e- CAbus& c 1 c ,Aczrp z-t SO E ✓l L-rtr r A-vr 11,57,20a- Ja rt Permit/Registration Holder Name Permit Exp.Date Total Time Inspection Type rn 11+7 j'6� P`1 6-3© '/� Gom[1 L�..i►� 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 N/A=Not Applicable COS=Corrected On Site t* lite TATTOO AND PERMANENT COSMETICS MACHINE' CLEANING AND STERILIZATION out oos «. SAFETY AND SANITATION our cos /O 1. Autoclave is approved and effective-passed El 0 n N/O 18. Safe machine design A integrator test NIA In N/0 2. Process of cleaning,labeling,packaging and 0 (Zn)N/0 19. Machines cleaned and disinfected between 0 NIA sterliziing items correct) N/A clients n N/O 3. Autoclave loaded correctly/packages allowed to 0 0 TWO 20. Parts replaced between clients-grommets, 0 0 N/A dry N/A elastic bands,etc. In NIO 4. Integrators used/monthly spore test/log PREVENTING CROSS-CONTAMINATION A maintained N/0 5. Decontamination/sanitation area separate and In N/O 21. Workstation/procedure area decontaminated 0 NIA supplied* /A N/0 6. Invoices and log kept for disposable,pre- In N/0 22. Chemical disinfectant used 0 to sterilized equipment,backu supplies available* !A Chemical used: ri n N/0 7. Sharps containers supplied,labeled,used and N/O 23. Disinfectant used sufficient contact time Wet 0 0 A disposed of corrects * NIA contact timeprovided: S N/0 8. Jewelry,tattoo and piercing equipment-storage gEnAlO 24. Barriers available and used as part of 0 NIA and use NIA procedure no N/0 25. Products applied to skin are single PRACTITIONER HEALTH AND HYGIENE N/A use/dispensed aseptically n O 9. No eating,drinking or smoking-clean clothes 0n N/0 26. Storage of inks,pigments,needles,tubes,etc., 0 0 A N/A IAO 10. Hands washed effectively and timely 0 0 n NA10 27. Jewelry,Inks,Needles etc approved and used 0 0 N!0 11. Handwashing facilities properly supplied and In&/ 28. Cross-contamination avoided during all phases 0 0 A accessible,warm potable water* NIA of procedure /0 12. Personal protective equipment available and ; BEST BUSINESS PRACTICES D El N/A I used,eyewash station available* 4 -�CUBTQMBRSICLIENT,$ In 0 29. Areas separated/no living or sleeping 0 0 N quarters/no animals In Nl 13. Branding is completed with no other customers in 0 0 In N/0 30. Floors and walls clean and in good repair, 0 procedure area N/A adequate light* n NIO 14. Customers eighteen(18)years of age or older 0 0 I N/O 31. Workstation,surfaces,including chairs,,etc.in 0 0 IA good repair;trash removed frequently* n IO 15. Skin prepared for procedure. 0 0n N/0 32, Permit/registration and required signs posted* ❑ ❑ N/A N/A IonIn NIO 16, Client records available-Consent form& 0 0 In N/O 33. IPCP and employee training records and 0 N/A questionnaire /A He atitiis B vaccination status present ON10 17. Aftercare instructions given to client n NIO 34 Restrooms available,stocked n 0 0 * D ❑ NIA NIA Received by(Print): Received by(Signature): Phone: Specialist(Print): Specialist(Signature): Phone: F1This report is an Official Notice of Violation.Corrections must be completed in the time specified. 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 1 of S