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Body Art Inspection Report Date(MM/DD/YY) - - County of San Joaquin County,Environmental Health Department 1868 E.Hazefton Ave.,Stockton CA 95205 Permit Number (209)468-3420 www.sinov.oro/ehd Permit Type �C�,ia Rig Facility Name Address city Zip Code CT Vi%y' Al tff - i Pen-nit/Registration Holder Name Permit Exp.Date Total Time Inspection Type 6170/ el&'4aij 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 NIA=Not Applicable COS=Corrected On Site Y ,S;`r.S7x�' '� 4� ` �€.� �' .,. CLE1(NGANM"STERIILiZATI � �, r . r {, 5 " CNC?SAITE4TIC?N7 In N/0 1. Autoclave is approved and effective-passed ❑ ❑ In N/O 18. Safe machine design ❑ ❑ /A int rator test N/A Un NIO 2. Process of cleaning,labeling,packaging and ® n N10 19. Machines cleaned and disinfected between ® ❑ N/A stedi7jing items corrects N/A clients N/O 3. Autoclave loaded correctly/packages allowed to In N/O 20. Parts replaced between clients-grommets, ❑ ❑ N/A dry NIA elastic bands,etc. In N/0 4. Integrators used/monthly spore tesUlog ® Y � PREVE tNG41QSSGONTAMSiN4rtlONa � k NIA maintained NIO 5. Decontamination/sanitation area separate and ❑ ❑ ON/0 21. Workstation/procedure area decontaminated ❑ ❑ N/A supplied* N/A In 0 6. Invoices and log kept for disposable,pre- ❑ ❑ In NIO 22. Chemical disinfectant used ❑ ❑ N! sterilized equipment,backup supplies available* NIA Chemical used: Iii-NIO 7. Sharps containers supplied,labeled,used and ® In NIO 23. Disinfectant used sufficient contact time Wet ❑ ❑ N/A disposed of correctly* N/A contact timeprovided: /Oat aG- I O 8. Jewelry,tattoo and piercing equipment-storage ❑ ® NIO 24. Barriers available and used as part of 13 131 and use N/A procedure ON `�t', in 1 25. Products applied to skin are single ❑ 13PR C RI(?NE N/ use/dis ensed asep Acally N NInIn NIO 9. No eating,drinking or smoking-clean clothes ❑ ❑ I NIO 26. Storage of inks,pigments,needles,tubes,etc., 13 ❑ !A N/A U NIO 10. Hands washed effectively and timely ❑ ❑ n N/0 27. Jewelry,Inks,Needles etc approved and used ❑ ❑ N/A /A In N/0 11. Handwashing facilities properly supplied and ® In 28. Cross-contamination avoided during all phases ❑ ❑ N/A accessible,warm table water* NV of procedure N/0 12, Personal protective equipment available and BEST BUS SSS pRCTlCS "" k3' ❑ ❑ N/A used,eyewash station available � Ct18Tit, R CANf � � � r � N 29. Areas separated/no living or sleeping in /0 ❑ ❑ u 22rffiw „ .ems ._t ,..,.. .� k / UaftefSlnO anlmalS In 13. Branding is completed with no other customers in ❑ ❑ in N/0 30. Floors and walls clean and in good repair, ❑ 1 I procedure area _N/A adequate light* I 10 14. Customers eighteen(18)years of age or older ® ® n N/0 31. Workstation,surfaces,including chairs,,etc.in ❑ ❑ N/A A ood repair;trash removed frequently* UIn N/0 15. Skin prepared for procedure, ® n N/0 32. Permit/registration and required signs posted* ❑ ❑ N/A ` N/A In N/0 16. Client records available-Consent form& ❑ in N/0 33. IPCP and employee training records and ❑ N/A questionnaire IA He atitiis B vaccination status present In WO 17. Aftercare instructions given to client ❑ In N10 34 Restrooms available,stocked* ❑ ❑ NIA NIA Received b (Print): Rece ved by(Signature): Phone: Specialist(Print): Specialist(Signature): Phone: This 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) Page of