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Name of Perm it/Registration Holder Permit Exp. Date Time In Time Out Inspection Type Ryann S. Silva Initial Consult. 1 No eating, drinking or smoking - clean clothes The above facility is inspected for compliance with Division 104, Hands washed effectively and timely Part 15, Chapter 7 of California Health and Safety Code (HSC). a°uI" Body Art Inspect Report Date: Hepatitis B vaccination ❑ C = Corrected On Site ❑ F San Joaquin County Environmental Health Department Program V MACHINE SAFETY AND SANITATION (cont.) 1868 E. Hazelton Ave., Stockton, CA 95205 Record: 1 \ �.. 9�1Fo"ae'�. (209) 468-3420 www.slogv.org/ehd Program Element: tl !a3 replaced between clients - grommets, elastic bands, ❑ ❑ J Facility Name Address City Zip Code Art Body & Soul Tattoo Lounge 3008 e. hammer lane 124 Stockton 95212 Name of Perm it/Registration Holder Permit Exp. Date Time In Time Out Inspection Type Ryann S. Silva Initial Consult. 1 No eating, drinking or smoking - clean clothes The above facility is inspected for compliance with Division 104, Hands washed effectively and timely Part 15, Chapter 7 of California Health and Safety Code (HSC). Handwashing facilities properly supplied and accessible, warm water ❑ V = Violation Hepatitis B vaccination ❑ C = Corrected On Site ❑ V CLEANING AND STERILIZATION C V MACHINE SAFETY AND SANITATION (cont.) C ❑ 1 Autoclave: approved and effective - passed integrator ❑ ❑ 22.7Parts replaced between clients - grommets, elastic bands, ❑ ❑ testetc. 35. Operation and employee training records present ❑ ❑ El 2' Items washed, disinfected, packaged, labeled, and 11PREVENTING ❑ 36. Plan(s) submitted for review ❑ ❑ sterilized ❑ 37. Permits obtained and available 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 Closure El ❑ ❑ 41. ❑ ❑ 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 ElSharps ® 7' containers labeled, used, and disposed of Elappropriately Wet contact time provided: El 8. Jewelry, tattoo and piercing equipment - clean and _, ❑ ® 26. 1 Barriers used ❑ PRACTITIONER HEALTH AND HYGIENE ❑ 9. 1 No eating, drinking or smoking - clean clothes ❑ 10. Hands washed effectively and timely ® 11. Handwashing facilities properly supplied and accessible, warm water ❑ 12. Hepatitis B vaccination ❑ 13. Bloodbome Pathogen training ❑ El Source: ❑ 14. Appropriate personal protective equipment available and CUSTOMERS/CLIENTS ❑ 15. Branding is completed with no other customers in procedure area ❑ 16. Customers eighteen (18) years of age or older ❑ 17. Skin adequately prepared for procedure ® 18 Client records approved and available - Consent form and questionnaire ® 19. 1 Appropriate aftercare instructions given to client MACHINE SAFETY AND SANITATION ❑ 20. Safe machine design ❑ 21. Machines cleaned and disinfected between clients Received REHS Received ❑ BEST El 27. Products applied to skin are single use/dispensed El ❑ 28. Storage of inks, pigments, needles, tubes, etc. ❑ ❑ 29. Jewelry, Inks, Needles etc approved and used correctly ❑ El 30. Cross -contamination avoided during all phases of ❑ BEST BUSINESS PRACTICES ❑ 31. Areas separated/no living or sleeping quarters ❑ El ® 32. Floors and walls clean and in good repair, adequate light ❑ ❑ ® 33. Workstation, surfaces, including chairs, armrests, etc. in good repair ❑ ❑ 34. Permit/registration posted ❑ ❑ ® 35. Operation and employee training records present ❑ ❑ COMPLIANCE AND ENFORCEMENT ❑ ❑ 36. Plan(s) submitted for review ❑ ❑ ❑ 37. Permits obtained and available ❑ ❑ ❑ 38. Impoundment ❑ ❑ 39. Hearing scheduled ❑ ❑ El 40. Closure El ❑ ❑ 41. ❑ a 9- Zoo -'$o Reinspecion on/about: A reinspection fee of $130 per hour may be charged. Page 1 of 3 EH -03/2015