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Body Art Ins{ Report M Date: I /3/1 <br /> _ Z San Joaquin County Environmental Health Department Pro '! <br /> a:a {', gram <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: <br /> o „P (209)468-3420 Program <br /> dt;FORP` www.sioqv.orq ram <br /> g/ehd <br /> Element: ' 03 <br /> Facility Name Address City Zip Code <br /> Lumiere Spa 15 w oak street Lodi 95240 <br /> Name of Perm it/Registration Holder Permit Exp.Date Time In Time Out Inspection Type <br /> Georgina Anaya 6/30/19 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 ❑ ❑ 22 Parts replaced between clients-grommets,elastic bands, ❑ <br /> test etc. <br /> ❑ <br /> Items washed,disinfected,packaged,labeled,and 2' 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 ❑ ® 24. Appropriate chemical disinfectant used <br /> Decontamination/sanitation area separated and supplied ❑ <br /> [j 5' E] Chemical used: CaviWipes <br /> appropriately <br /> Invoices and log kept for disposable,pre-sterilized <br /> ® 6 equipment ❑ ❑ 25. Disinfectant used appropriately/sufficient contact time <br /> ® 7 Sharps containers labeled,used,and disposed of ❑ <br /> ElWet contact time provided: 3 mins <br /> appropriately <br /> ❑ 8 Jewelry,tattoo and piercing equipment-clean and <br /> sterilized El El26. Barriers used El <br /> ® 27 Products applied to skin are single use/dispensed ElPRACTITIONER HEALTH AND HYGIENE 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 ❑ ❑ 29. Jewelry, Inks, Needles etc approved and used correctly ❑ <br /> ❑ 11. Handwashing facilities property supplied and accessible, ❑ ❑ 30 Cross-contamination avoided during all phases of ❑ <br /> warm water procedure <br /> ❑ 12. Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES <br /> ® 13. Bloodbome Pathogen trainingElEl31. Areas separated/no Irving or sleeping quarters ❑ <br /> Source: ❑ 32. Floors and walls clean and in good repair,adequate light ❑ <br /> ❑ 14. Appropriate personal protective equipment available and ❑ ❑ 33 Workstation,surfaces,including chairs,armrests,etc.in Elused good repair <br /> CUSTOMERS/CLIENTS ® 34. Permit/registration posted ❑ <br /> ❑ 15. Branding is completed with no other customers in <br /> rocedure area ❑ ® 35. Operation and employee training records present ❑ <br /> ® 16. Customers eighteen(18)years of age or older ❑ COMPLIANCE AND ENFORCEMENT <br /> ® 17. Skin adequately prepared for procedure ❑ ❑ 36. Plan(s)submitted for review ❑ <br /> ® 18 Client records approved and available-Consent form ❑ <br /> El ❑ 37. Permits obtained and available <br /> and questionnaire <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 /> :A Received b (Print): Tana Vrismo Received b (Signature Phone: 209 712-9956 <br /> Specialist(Print): Mai Vue Specialist(Si nature : Phone: 209 468-3284 <br /> Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Page 1 of 3 <br /> EH-11/17 <br />