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~ Body Art Inspectib Report Date: San Joaquin County Environmental Health Department Program 1868 E. Hazelton Ave., Stockton, CA 95205 Record: Pao S 2St (209) 468-3420 R; Program www.siogv.org/ehd Element: y �� Facility Name Address City Zip Code Blue Moon Tattoo/Piercing 2306 east street Tracy 95376 Name of Permit/Registration Holder Permit Exp. Date Time In Time Out Inspection Type Dhanoya, Amanjit 6/30/19 Routine The above facility is inspected for compliance with Division 104, Part 15, Chapter 7 of California Health and Safety Code (HSC). V = Violation C = Corrected On Site t's`'� 4 4 l.yd xFi ••�� P �,yI�':i a° IiP c`€s �s sem`&. �'bv55i" .ii ii i`r 604,k ® Autoclave: approved and effective - passed integrator ❑ ❑ 22 Parts replaced between clients - grommets, elastic bands, ❑ 1 test etc. El 2 Items washedRM , disinfected, packaged, labeled, and E] F �,%< 3" F __ _ PI'Ppi 9tlhtilll Op - P.�k�� sterilized ❑ 23. Workstation/procedure area decontaminated ❑ ❑ 3. Autoclave loaded correctly/packages allowed to dry ❑ ® 4. Integrators used/monthly spore test/log maintained ❑ ❑ 24. Appropriate chemical disinfectant used ❑ El 5' Decontamination/sanitation area separated and supplied ElChemical used: appropriately® 6. Invoices and log kept for disposable, pre -sterilized ❑ El 25. Disinfectant used appropriately/sufficient contact time equipment ❑ ® 7' Sharps containers labeled, used, and disposed of E]appropriately [Wet contact time provided: ® 8. Jewelry, tattoo and piercing equipment - clean and ❑ ❑ 26. Barriers used ❑ sterilized �`. �I �. ❑ 27. Products applied to skin are single use/dispensed :. n... aseptically❑ ❑ 28. Storage of inks, pigments, needles, tubes, etc. ❑ ® 9. No eating, drinking or smoking - clean clothes ❑ ❑ 10. Hands washed effectively and timely ❑ ❑ 29. Jewelry, Inks, Needles etc approved and used correctly ❑ ® 11. Handwashing facilities properly supplied and accessible, El ❑ 30. Cross -contamination avoided during all phases of ❑ warm water procedure ® 12. Hepatitis B vaccination P ❑ �� 2 � ® 31. Areas separated/no living or sleeping quarters ❑ ® 13. Bloodborne Pathogen training ❑ Source: ® 32. Floors and walls clean and in good repair, adequate light ❑ El Appropriate personal protective equipment available and ❑ ® 33'good Workstation, surfaces, including chairs, armrests, etc. in ❑ 14. used repair 34. Permit/registration posted El 35. Operation and employee training records present El® ❑ 15. Branding is completed with no other customers in El procedure area ❑ 16. Customers eighteen (18) years of age or older ❑ �y ❑ 17. Skin adequately prepared for procedure ❑ ❑ 36. Plan(s) submitted for review ❑ ® 18. Client records approved and available - Consent form El® 37. Permits obtained and available E]and i questionnaire ® 19. Appropriate aftercare instructions given to client ❑ ❑ 38. Impoundment ❑ i�tiI��P„kik.. ii. s�,,.;� � ® 39. Hearn scheduled g ❑ `.. �I, ...h.ti� t ❑ 40. Closure ❑ ❑ 20. Safe machine design ❑ ❑ 21. Machines cleaned and disinfected between clients ❑ ❑ 41. ❑ Received by (Print): EmAi iED Received by (Signature): Phone: Specialist (Print): ��U-5ZA Specialist (Signature): Phone: (meq] q53 -�31a Reinspecion on/about: A reinspection fee of $152 per hour may be charged. Page 1 of 4 EH -11/17