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r� ,{ Body Art Inspeca Report 41 Date: 1 Stu I San Joaquin County Environmental Health Department Program 1868 E. Hazelton Ave., Stockton, CA 95205 Record: '"4-0 53701(0 if (209) 468-3420 Program 9 ` www.sioay.orq/ehd Element: Facility Name Address City Zip Code Art Body and Soul 3008 e. hammer lane Stockton 95212 Name of Perm it/Registration Holder Permit Exp. Date Time In Time Out Inspection Type Ryann Silva 6/30/19 200pm 225pm Complaint 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 we �, r ❑ 1 Autoclave: approved and effective - passed integrator ❑ ❑ 22 Parts replaced between clients - grommets, elastic bands, ❑ test etc. El 2 Items washed, disinfected, packaged, labeled, and ❑ '`11 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 El Decontamination/sanitation area separated and supplied 5' El Chemical used: ai)Dror)riatelv El Invoices and log kept for disposable, pre -sterilized 6' El El 25. Disinfectant used appropriately/sufficient contact time equipment E]Sharps El containers labeled, used, and disposed of 7' ❑ Wet contact time provided: ro riatel appropriately El El Jewelry, tattoo and piercing equipment - clean and 8. 8' El El 26. Barriers used E]sterilizedMV �� '� „ El 27 Products applied to skin are single use/dispensed ❑ �{ , d w 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 ❑ El 11. Handwashing facilities properly supplied and accessible, ❑ ❑ 30' Cross -contamination avoided during all phases of E] warm water procedure ❑ 12. Hepatitis B vaccination ❑ �� ❑ 31. -x - �l i Areas separated/no living or sleeping quarters �' ❑ ❑ 13. Bloodborne Pathogen training ❑ Source: ❑ 32. Floors and walls clean and in good repair, adequate light ❑ ❑ 14. Appropriate personal protective equipment available and ❑ ❑ 33 Workstation, surfaces, including chairs, armrests, etc. in ❑ used good repair �r'"',;n��a��'��( - r ❑ 34. Permit/re it/registration posted 9 ❑ S �d��kim ❑ 15. Branding is completed with no other customers in E]❑ 35. Operation and employee training records present Elrocedure area ❑ 16. Customers eighteen (18) years of age or older ❑ ❑ 36. Plan(s) submitted for review ❑ ❑ 17. Skin adequately prepared for procedure ❑ El 18. Client records approved and available - Consent form El El 37. Permits obtained and available Eland questionnaire ❑ 19. Appropriate aftercare instructions given to client ❑ ❑ 38. Impoundment ❑ ❑ 39. Hearing scheduled ❑ ❑ 40. Closure ❑ ❑ 20. Safe machine design ❑ ❑ 21. Machines cleaned and disinfected between clients ❑ ❑ 41. ❑ Received b (Print): i Received by (Signature): Phone: Specialist (Print): W11_ C(4 Ilm/a Specialist (Signature): Phone: Z,(1 #68 M3Z Reinspecion on/about: A reinspection fee of $152 per hour may be charged. Page 1 of 2 EH -11/17