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°`f If, <br /> � Body Art Inspection ItiReport <br /> ^ � 2 Date: 7�! O <br /> San Joaquin County Environmental Health Department Program <br /> a { 1868 E.Hazelton Ave.,Stockton,CA 95205 <br /> (209)468-3420 Record: DC7 5 ri�0 3 3 <br /> Program <br /> www.sioqv.org/ehd Element: y f, <br /> Facility Name Address City Zip Code <br /> Lumiere Spa 15 w oak st Lodi 95240 <br /> Name of Permit/Registration Holder Permit Exp. Date Time In Time Out Inspection Type <br /> Georgina Anaya 6/1/21 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 integratorParts replaced between clients-grommets,elastic bands, Eltest E] E] 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 ❑ ❑ 24. Appropriate chemical disinfectant used <br /> ❑ 5 Decontamination/sanitation area separated and supplied Elappropriately <br /> El Chemical used: <br /> ® 6 Invoices and log kept for disposable,pre-sterilized <br /> equipment El 25. Disinfectant used appropriately/sufficient contact time <br /> ® 7 Sharps containers labeled, used, and disposed of ❑ <br /> a ro riatel El Wet contact time provided: <br /> ❑ 8 Jewelry,tattoo and piercing equipment-clean and <br /> El El 26. Barriers used E]sterilized <br /> ❑ 27 Products applied to skin are single use/dispensed ❑ <br /> PRACTITIONER 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 /> Handwashing facilities properly supplied and accessible, Cross-contamination avoided during all phases of <br /> ❑ 11. warm water F1 ❑ 30' procedure El <br /> ❑ 12. Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES <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 /> ❑ 14 Appropriate personal protective equipment available and Workstation,surfaces,including chairs,armrests,etc.in <br /> used ❑ ❑ 33. good repair <br /> El <br /> CUSTOMERS/CLIENTS ❑ 34. Permit/registration posted ❑ <br /> Branding is completed with no other customers in <br /> El 15. ❑ ® 35. Operation and employee training records present Elrocedure area <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 /> ® <br /> Client records approved and available-Consent form 18. El El37. Permits obtained and available Elandquestionnaire <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): Georgina Ana a Received by(Signature): i M Al t. - Phone: <br /> Specialist(Print): Sandip Singh Specialist(Signature): ( Phone: 209-468-3526 <br /> r4 a <br /> Reinspecion on/about: A reinspection fee of$152 per hour may be charged. Page 1 of 3 <br /> EH-11/17 <br />