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U! �" i° ;...... co Body Art Inspect Report Date: I'1I.7 V San Joaquin County Environmental Health Department Program ❑ 1 1868 E. Hazelton Ave., Stockton, CA 95205 Record: P2os313'i$ �q•.;:...... ,e t,FOR� (209) 468-3420 www.siogv.org/ehd Program U 2 Items washed, disinfected, packaged, labeled, and sterilized Element: Facility Name Address City Zip Code Wicked Wayz 920 s. cherokee In. #a Lodi 95240 Name of Permit/Registration Holder Permit Exp. Date Time In Time Out Inspection Type Mohamed Abdullah 6/30/16 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 V I CLEANING AND STERILIZATION C V I MACHINE SAFETY AND SANITATION (cont) C ❑ 1 Autoclave: approved and effective - passed integrator test ❑ ❑ 22 Parts replaced between clients - grommets, elastic bands, etc. El' ❑ 2 Items washed, disinfected, packaged, labeled, and sterilized El 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 ❑ ❑ 5 Decontamination/sanitation area separated and supplied appropriately ❑ Chemical used: ® 6 Invoices and log kept for disposable, pre -sterilized equipment F1 [__125. Disinfectant used appropriately/sufficient contact time Elappropriately❑ ❑ 7 Sharps containers labeled, used, and disposed of Wet contact time provided: ❑ 8. Jewelry, tattoo and piercing equipment - clean and ❑ El 26. Barriers used Elsterilized HEALTH AND HYGIENE ❑ 27 Products applied to skin are single use/dispensed aseptically ElPRACTITIONER ❑ 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 ❑ ❑ 11 Handwashing facilities properly supplied and accessible, warm water ❑ ❑ 30. Cross -contamination avoided during all phases of procedure ❑ ❑ 12. 1 Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES ® 13. Bloodbome Pathogen trainingEl❑ 31. Areas separated/no living or sleeping quarters El Source: ❑ 32. Floors and walls clean and in good repair, adequate light ❑ ❑ 14. Appropriate personal protective equipment available and used ❑ ❑ 33 Workstation, surfaces, including chairs, armrests, etc. in good repair ❑ CUSTOMERS/CLIENTS ❑ 34. Perm ittregistration posted ❑ ❑ 15. Branding is completed with no other customers in rocedure area El El 35. Operation and employee training records present ❑ ® 16. Customers eighteen (18) years of age or older ❑ COMPLIANCE AND ENFORCEMENT ❑ 17. Skin adequately prepared for procedure ❑ ❑ 36. Plan(s) submitted for review ❑ ❑ 18 Client records approved and available - Consent form and uestionnaire El F137. Permits obtained and available ❑ ❑ 19. Appropriate aftercare instructions given to client ❑ ❑ 38. Impoundment ❑ MACHINE SAFETY AND SANITATION ❑ 39. Hearing scheduled ❑ ❑ 20. Safe machine design ❑ ❑ 40. Closure ❑ ❑ 21. Machines cleaned and disinfected between clients ❑ ❑ 41. ❑ Received b (Print): Terry Minatre Received by (Signature): V�q�one209)339-1779 Specialist (Print): Benjamin Escotto, Sr REHS Specialist (Signature): Phone: 209 468-3178 Reinspecion on/about: A reinspection fee of $130 per hourmaybe charged. Pagellof 2 EH -03/2015