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Body Art Inspect*Report Date: 5/3A <br /> San Joaquin County Environmental Health Department Program p 2 c� <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: ` Z OS J 2 t 2 <br /> (209)468-3420 Program / 1 <br /> gt F Ra`P www.sjogv org/ehd Element: CA 12.0 <br /> Facility Name Address City Zip Code <br /> Fawn Yee's Permanent Cosmetics 6231 pacific ave#3 Stockton 95207 <br /> Name of Permit/Registration Holder Permit Exp.Date Time In Time Out Inspection Type <br /> Fawn Y. Liang 6/30/16 Routine <br /> The above facility is inspected for compliance with Division 104,Part 15,Chapter 7 of California Health and Safety Code(HSC). <br /> V=Violation C=Corrected On Site <br /> V CLEANING AND STERILIZATION C V MACHINE SAFETY AND SANITATION(cont) C <br /> ❑ 1 Autoclave:approved and effective-passed integrator Parts replaced between clients-grommets,elastic bands, <br /> test ❑ El 22' etc. ❑ <br /> ❑ 2 Items washed,disinfected,packaged,labeled,and <br /> sterilized El CROSS-CONTAMINATION <br /> ❑ 3. Autoclave loaded correctly/packages allowed to dry ❑ ❑ 23. Workstation/procedure area decontaminated ❑ <br /> ❑ 4. Integrators used/monthly spore test/log maintained [1 ❑ 24. Appropriate chemical disinfectant used <br /> Decontamination/sanitation area separated and supplied ❑ <br /> ❑ 5' appropriately ❑ Chemical used: Cavicide <br /> Invoices and log kept for disposable,pre-sterilized <br /> ® 6. equipment El El25. Disinfectant used appropriately/sufficient contact time <br /> ElSharps containers labeled,used,and disposed of <br /> ❑ 7' ❑ Wet contact time provided: 2 mins,then 3 mins <br /> appropriately <br /> ❑ <br /> Jewelry,tattoo and piercing equipment-clean and 8. ❑ El 26. Barriers used Elsterilized <br /> Products applied to skin are single use/dispensed <br /> PRACTITIONER HEALTH AND HYGIENE El 27. asepticallyEl <br /> ❑ 9. No eating,drinking or smoking-clean clothes ❑ ❑ 28. Storage of inks,pigments,needles,tubes,etc. ❑ <br /> ❑ 10. Hands washed effectively and timely ❑ ❑ 29. Jewelry, Inks,Needles etc approved and used correctly ❑ <br /> ❑ <br /> Handwashing facilities properly supplied and accessible, Cross-contamination avoided during all phases of 11. warm water El ❑ 30. procedure <br /> E] <br /> ❑ 12. Hepatitis B vaccinationLIE] <br /> BEST BUSINESS PRACTICES <br /> F-113. Bloodborne Pathogen training ❑ 31. Areas separated/no living or sleeping quarters ❑ <br /> Source: Cathy Montie ❑ 32. Floors and walls clean and in good repair,adequate light ❑ <br /> ❑ <br /> Appropriate personal protective equipment available and Workstation,surfaces,including chairs,armrests,etc.in 14. used El ❑ 33. good repair ❑ <br /> CUSTOMERS/CLIENTS ❑ 34. Permit/registration posted ❑ <br /> Branding is completed with no other customers in <br /> El 15. rEEJ] <br /> El 35. Operation and employee training records present <br /> procedure area <br /> ❑ <br /> El16. Customers eighteen(18)years of age or older COMPLIANCE AND ENFORCEMENT <br /> El 17. Skin adequately prepared for procedure ❑ 36. Plan(s)submitted for review ❑ <br /> ® <br /> Client records approved and available-Consent form Eland questionnaire <br /> 18' [I E] 37. Permits obtained and available <br /> ❑ 19. Appropriate aftercare instructions given to client ❑ ❑ 38. Impoundment ❑ <br /> MACHINE SAFETY AND SANITATION ❑ 39. Hearing scheduled ❑ <br /> ❑ 20. Safe machine design ❑ ❑ 40. Closure ❑ <br /> ❑ 21. Machines cleaned and disinfected between clients ❑ ❑ 41. ❑ <br /> Received b (Print): Fawn Y.Liang Received by(Signature): Phone:(209)478-1266 <br /> Specialist(Print): Harprit Mattu,Sr REHS Specialist(Signature): Phone: 209 468-3284 <br /> Reinspecion on/about: A reinspection fee of$130 per hour may be charged. Page 1 of 2 <br /> EH-03/2015 <br />