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Lil <br />contaminated items, such as gloves. (California Health and safety Code 119311 (a) and 119314 <br />(d)) <br />A lined and lidded trash bin is located in the treatment area to dispose of any contaminated <br />trash. <br />R. Negative/Failed Spore Test: Describe the procedure conducted when a monthly spore test <br />has failed. Indicate whether the facility maintains a spore test log on-site. (California Health and <br />safety Code 119315 (b)(2)(4)) <br />N/A <br />S. Commercial Ink or Pigment Manufacturers: List the manufacturer for the inks or pigments <br />used at the body art facility. Describe the procedure for dilution of inks. Only sterile water should <br />be used for dilution of inks or pigments. (California Health and Safety Code 119311 (b)(c)(d)(e)) <br />Manufacturer — Deluxe Brows <br />There is no dilution of inks. <br />T. Permanent Cosmetic Machine Name and Manufacturer: Provide the model name and number <br />for the permanent cosmetic machine used. (California Health and Safety Code 119311 (i)0)) <br />N/A <br />U. Service Animals: Describe the facility's policy regarding service animals allowance in procedure <br />or decontamination and sterilization areas. (California Health and Safety Code 119314 (f)) <br />Service animals prohibited in treatment area <br />Maintain a copy of this document in your files. Submit one copy to the Local Enforcement Agency. <br />I hereby certify that all body art practitioners performing body art at this facility and <br />employees or individuals involved with decontamination and sterilization procedures have <br />been trained with the procedures and information contained in this document and to the best <br />of my knowledge and belief, the statements made herein are correct and true. <br />Signature: <br />Page 8 of 12 <br />Date: <br />