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ou1NDate(MM/DD/YY) �/ co Body Art Inspection Report y County of San Joaquin County,Environmental Health Department n r . (209)468-3420 www.siaov.oro/ehd Permit Type �t) -, Facility Name Address City Zip Code CT 1Lc,inCYS, 'mow ZA41-_1 212�t 1-. 44A L-Cr'�b `i__3 J" _Ssef r_ J tt1 44nl "11 Permit/Registration Holder N me Permit Exp.Date Total Time Inspection Type SlntLri 'ti� I,J: ;.n1 lsoi13 RISK FACTORS AND INTERVENTIONS Risk factors are improper practices or procedures identified as contributing factors of cross-contamination. Interventions are control measures to prevent cross-contamination and transfer of pathogens from one person to another. In=In Compliance Out=Not in Compliance N/O=Not Observed N/A Not Applicable COS=Corrected On Site 01 -4" .,E r cosMErlc 'l-MCHl � ' , CLEANING AND STERILIZATION our' cos _ SSA IT TION �� ". .� �.`cosi n NIO 1. Autoclave is approved and effective-passed 0 0 Uji)NIO 18. Safe machine design /A integrator test XA I N/O 2. Process of cleaning,labeling,packaging and 10 19. Machines cleaned and disinfected between 0 0 WA sterliziing items correct) A clients Uln'n N/0 3. Autoclave loaded correctly/packages allowed to 0 N/O 20. Parts replaced between clients-grommets, 0 0 N/A dry NIA elastic bands,etc. In N/O 4. Integrators used/monthly spore testllog PRO& 7 ROS ONTAMINATIO NIA maintained NIO 5. Decontamination/sanitation area separate and N/O 21. Workstation/procedure area decontaminated IA supplied* NIA r5 NIO 6. Invoices and log kept for disposable,pre- NIO 22. Chemical disinfectant used CpH- 4Z�13 13 0 13 N/A sterilized equipment,backup supplies available* !A Chemical used: In N/0 7. Sharps containers supplied,labeled,used and N/O 23. Disinfectant used sufficient contact time Wet 0 0 /A disposed of correct) * N/A contact timeprovided: r IMA*Vf;- (QO/O 8. Jewelry,tattoo and piercing equipment-storage Ei ❑ rS N/O 24. Barriers available and used as part of 0 0 NIA and use N/A procedure N/0 25. Products applied to skin are single d_PRACTITIONER HEA13 13 LTH AND HYGIENE to useldis ensed ase tical) In' 0 9. No eating,drinking or smoking-clean clothes Ei Ei NIO 26. Storage of Inks,pigments,needles,tubes,etc., 0 0 IA /A N/O 10. Hands washed effectively and timely 0 0 n NIO 27. Jewelry,Inks,Needles etc approved and used 13 N/A NIA NIO 11. Handwashing facilities properly supplied and In N/0 28. Cross-contamination avoided during all phases 11 /A accessible,warm potable water* NIA of procedure Un NIO 12. Personal protective equipment available and N/A used,eyewash station available* s. ",�r '�° CUS`0`..A In 29. Areas separated/no living or sleeping 11 El ;.; (NIA,) quarters/no animals* In XQ 13. Branding is completed with no other customers in 0 0 n NIO 30. Floors and walls clean and in good repair, 0 0 procedure area /A adequate light* 0 14. Customers eighteen(18)years of age or older 0 0 Y N/O 31. Workstation,surfaces,including chairs,,etc.in 'N/A11 0 A ood re air;trash removed fre uentl * Un N/0 15. Skin prepared for procedure. 0 0 NIO 32. Perm itlregistration and required signs posted* 0 0 N/A NIA In N/O 16. Client records available-Consent form& In NIO 33. IPCP and employee training records and NIA questionnaire A He atitiis B vaccination status present In N/0 17. Aftercare instructions given to client gL 0 n /0 34 Restrooms available,stocked N/A NIA Received b (Print): t Received by(Signature): Phone: Specialist(Print): Specialist(Signature): Phone: F1This report is an Official Notice of Violation.Corrections must be completed in the time specified. A reinspection fee may be charged if violations noted on this report are not corrected by the reinspection date. Reinspection Date(on or about) Pagel.-of_Z41'