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4 1 Autoclave: approved and effective - passed integrator ❑ U ,.��....�o Bod ect* Re Y Art Ins P Port 22 Parts replaced between clients -grommets, elastic bands, El Date: San Joaquin County Environmental Health Department Program I etc. 1868 E. Hazelton Ave., Stockton, CA 95205 Record: Lia ' . • ,c<qt (209) 468-3420 Program g F°oR`p www.siogv.orq/ehd Element: sterilized Facility Name Address City Zip Code Art Body & Soul Tattoo Lounge 3008 e. hammer lane 124 Stockton 95212 Name of Permit/Registration Holder Permit Exp. Date Time In Time Out Inspection Type Ryann S. Silva Final/Routine. The above facility is inspected for compliance with Division 104, Part 15, Chapter 7 of California Health and Safety Code (HSG). V = Violation C = Corrected On Site V CLEANING AND STERILIZATION C V MACHINE SAFETY AND SANITATION cont.) C ❑ 1 Autoclave: approved and effective - passed integrator ❑ ❑ 22 Parts replaced between clients -grommets, elastic bands, El I etc. ❑ 2" Items washed, disinfected, packaged, labeled, and El sterilized CROSS -CONTAMINATION ❑ 3. Autoclave loaded correctly/packages allowed to dry ❑ ❑ 23. Workstation/procedure area decontaminated ❑ ❑ 4. Integrators used/monthly spore test/log maintained ❑ ❑ 24. Appropriate chemical disinfectant used ❑ El 5' Decontamination/sanitation area separated and supplied ElChemical used: Cavi -wipes ro riatel appropriately ® 6. 6. Invoices and log kept for disposable, pre -sterilized ❑ ❑ 25. Disinfectant used appropriately/sufficient contact time equipment ❑ F1 7. Sharps containers labeled, used, and disposed of ElWet contact time provided: 3 minutes appropriately I ❑ 8' Jewelry, tattoo and piercing equipment - clean and ❑ ❑ 26. Barriers used Elsterilized El 27' Products applied to skin are single use/dispensed PRACTITIONER HEALTH AND HYGIENE asepticallyEl ❑ 9. No eating, drinking or smoking - clean clothes ❑ ❑ 28. Storage of inks, pigments, needles, tubes, etc. ❑ ❑ 10. Hands washed effectively and timely ❑ ❑ 29. Jewelry, Inks, Needles etc approved and used correctly ❑ El 11. Handwashing facilities properly supplied and accessible, El ❑ 30' Cross -contamination avoided during all phases of ❑ ,Harm water procedure ❑ 12. Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES ® 13. Bloodborne Pathogen training Areas separated/no living or sleeping quarters ElSource: ElEl31. Cathie Montie ❑ 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 CUSTOMERS/CLIENTS ❑ 34. Permit/registration posted ❑ El 15. Branding is completed with no other customers in ElEl❑ 35. Operation and employee training records present procedure area ❑ 16. Customers eighteen (18) years of age or older ❑ COMPLIANCE AND ENFORCEMENT ❑ 17. Skin adequately prepared for procedure ❑ ❑ 36. Plan(s) submitted for review ❑ El 18. Client records approved and available - Consent form -1® 37. Permits obtained and available E] and questionnaire ❑ 19. Appropriate aftercare instructions given to client ❑ ❑ 38. Impoundment ❑ MACHINE SAFETY AND SANITATION ❑ 39. Hearing scheduled ❑ ❑ 20. Safe machine design ❑ ❑40. Closure El ❑ 21. Machines cleaned and disinfected between clients El El :41. ❑ Received b (Print): R ann S. Silva Received by (Signature): Phone: (209) 200 - 3087 Specialist (Print): Har rit Mattu, Sr REHS Specialist (Signature): Phone: (209) 468-3284 Reinspecion on/about: A reinspection fee of $130 per hour may be charged. Page 1 of 2 EH -03/2015