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Body Art Inspectiai5 Report Date: <br /> San Joaquin County Environmental Health Department Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: <br /> (209)468-3420 Program <br /> www.siogv.org/ehd Element: <br /> Facility Name Address City Zip Code <br /> Name of Permit/Registration Holder Permit Exp. Date Time In Time Out Inspection Type <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 /> _ - <br /> �;v .ate' - <br /> 4 ,�� ti04 <br /> ._� . <br /> ❑ 1 Autoclave:approved and effective-passed integrator ❑ ❑ 22 Parts replaced between clients-grommets,elastic bands, E]test etc. <br /> ❑ 2 Items washed,disinfected, packaged, labeled,and ❑ i� ___a <br /> sterilized PREVENTING CRASS-Ct7 <br /> ❑ 3. Autoclave loaded correctly/packages allowed to dry ❑ ❑ 23. Workstation/procedure area decontaminated ❑ <br /> ❑ 4. Integrators used/monthly spore test/log maintained ❑ ❑ 24. Appropriate chemical disinfectant used <br /> Decontamination/sanitation area separated and supplied ❑ <br /> ❑ 5. appropriately ❑ Chemical used: <br /> -01 6 Invoices and log kept for disposable, pre-sterilized ❑ ❑ 25. Disinfectant used appropriately/sufficient contact time <br /> /714 equipment ❑ <br /> ❑ <br /> Sharps containers labeled, used,and disposed of `7' Elappropriately <br /> [Wet contact time provided: <br /> Jewelry,tattoo and piercing equipment-clean and <br /> EI 8. E] 26. Barriers used Elsterilized <br /> UIr,I Products applied to skin are single use/dispensed ❑ <br /> Ir ,T11 27. aseptically <br /> ❑ 9. No eating,drinking or smoking-clean clothes ❑ 28. Storage of inks,pigments, needles,tubes,etc. ❑ <br /> ❑ 10. Hands washed effectively and timely ❑ 4 29. Jewelry, Inks, Needles etc approved and used correctly ❑ <br /> 11. Handwashing facilities properly supplied and accessible, ❑ 30 Cross-contamination avoided during all phases of ❑ <br /> warm water procedure <br /> h ` <br /> ❑ 12. Hepatitis B vaccination ❑ n 9 ti E <br /> k0l ' a it l}S�FiES�s'PR,4G71 1 a d iIIl i�p ilai ahaF <br /> ❑ 13. Bloodborne Pathogen training ❑ ❑ 31. Areas separated/no living or sleeping quarters ❑ <br /> Source: 32. Floors and walls clean and in good repair,adequate light ❑ <br /> ❑ <br /> Appropriate personal protective equipme available an Workstation,surfaces, including chairs,armrests,etc. in 14. used ❑ 33'go repair ❑ <br /> � , �� � �„ ❑ 34ERS <br /> . Permit/registration posted E] <br /> ❑ <br /> Branding is completed with no other customers in 15. El El 35. Operation and employee training records present E]procedure area <br /> ❑ 16. Customers eighteen(18)years of age or older ❑ RT <br /> 17. Skin adequately prepared for procedure ❑ ❑ 36. Plan(s)submitted for review ❑ <br /> 18 Client records approved and available-Consent form ❑ ❑ 37. Permits obtained and available ❑ <br /> and questionnaire <br /> 19. Appropriate aftercare instructions given to client ❑ ❑ 38. ImpoundmentkMo <br /> ❑ <br /> . ti21il ❑ 39. Hearing scheduled ❑ <br /> . .�r A Eo�< , x W <br /> ❑ 20. Safe machine design ❑ ❑ 40. Closure ❑ <br /> ❑ 21. Machines cleaned and disinfected between clients ❑ ❑ 41. ❑ <br /> Received by(Print): Received by(Signature): eW5kAt� -""Phone: <br /> Specialist(Print): Specialist(Signature): Phone: <br /> Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Page 1 of 2 <br /> EH-11/17 <br />