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�O�9 .C4N <br /> Body Art Inspect*Report Date: / 2-L/3 ) / <br /> San Joaquin County Environmental Health Department Program <br /> N <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 <br /> Record: <br /> P' (209)468-3420 Program <br /> wwwsioqv.org/ehd 4//�4 V M -r4 j6< e1#1 A1L.COM Element: �l f2f <br /> Facility Name Address City Zip Code <br /> Stockton Tattoo 742 e.weber ave. Stockton 95202 <br /> Name of Permit/Registration Holder Permit Exp.Date Time In Time Out Inspection Type <br /> Angel Ugarte Consultation <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 ❑ ❑ 2 2j Parts replaced between clients-grommets,elastic bands, ❑ <br /> tp� test etc. <br /> Items washed,disinfected,packaged,labeled,and <br /> El 2' sterilized El CROSS-CONTAMINATION <br /> 3. Autoclave loaded correctly/packages allowed to dry rEl <br /> El 23. Workstation/procedure area decontaminated ElF-14. Integrators used/monthly spore test/log maintained F] 24. Appropriate chemical disinfectant used� Decontamination/sanitation area separated and supplied ElT 5' a ro riatel <br /> ` Chemical used: <br /> 14 Invoices and log kept for disposable,pre-sterilized <br /> LID, 6. a ui ment ❑ ❑ 25. Disinfectant used appropriately/sufficient contact time <br /> ❑ <br /> Sharps containers labeled,used,and disposed of <br /> ❑ 7� ❑ Wet contact time provided: <br /> appropriately <br /> Jewelry,tattoo and piercing equipment-clean and <br /> ❑ 8. sterilized ❑ El26. Barriers used ❑ <br /> Products applied to skin are single use/dispensed <br /> PRACTITIONER HEALTH AND HYGIENE ❑ 2T aseptically El <br /> 9. No eating,drinking or smoking-clean clothes ❑ El 28. Storage of inks,pigments,needles,tubes,etc. El <br /> ❑ 10. Hands washed effectively and timely ❑ ❑ 29. Jewelry, Inks, Needles etc approved and used correctly ❑ <br /> Handwashing facilities properly supplied and accessible, Cross-contamination avoided during all phases of <br /> ❑ 11. warm water ❑ El 30. procedure <br /> El <br /> ❑ 12. Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES <br /> ❑ 13. Bloodbome Pathogen training ❑ ❑ 31. Areas separated/no living or sleeping quarters ❑ <br /> Source: 32. Floors and walls clean and in good repair,adequate light ❑ <br /> Appropriate personal protective equipment available and Workstation,surfaces,including chairs,armrests,etc. in <br /> ❑ 14. used El ❑ 33' good repair <br /> El <br /> CUSTOMERSICLIENTS ❑ 34. Permit/registration posted ❑ <br /> Branding is completed with no other customers in <br /> El 15. ❑ El 35. Operation and employee training records present <br /> procedure area <br /> ❑ 16. Customers eighteen(18)years of age or older ❑ COMPLIANCE AND ENFORCEMENT <br /> ❑ 17. Skin adequately prepared for procedure ❑ E] 36. Plan(s)submitted for review El <br /> 18 Client records approved and available-Consent form ❑ ❑ 37. Permits obtained and available ❑ <br /> and questionnaire <br /> 35 19. 1 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): Yi car Received b Si nature): Phone: L e7 - <br /> Specialist(Print): J.Easter Specialist S nature: Phone: 209 953-7310 <br /> Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Page 1 of 3 <br /> EH-11/17 <br />