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°to. Body Art InspeA Report � Date: J l� 3 31 San Joaquin County Environmental Health Department 1868 E. Hazelton Ave., Stockton, CA 95205 Program Record: PO -ON mi o „P (209) 468-3420 Program www.siogv org/ehd Element: LA U Facility Name Address City Zip Code Teleios Tattoo 3414 delaware ave. Stockton 95204 Name of Permit/Registration Holder Permit Exp. Date Time In Time Out Inspection Type Daniel Hirschler 6/30/16 Routine The above facility is inspected for compliance with Division 104, Part 15, Chapter 7 of California Health and Safety Code (HSC). V = Violation C = Corrected On Site V CLEANING AND STERILIZATION C V MACHINE SAFETY AND SANITATION (cont.) C ❑ 1 Autoclave: approved and effective - passed integrator ❑El 22 Parts replaced between clients - grommets, elastic bands, Eltest etc. ❑ 2 Items washed, disinfected, packaged, labeled, and ❑ sterilized PREVENTING CROSS -CONTAMINATION ❑ 3. Autoclave loaded correctly/packages allowed to dry ❑ ❑ 23. 1 Workstation/procedure area decontaminated ❑ ❑ 4. Integrators used/monthly spore test/log maintained ❑ ❑ 24. Appropriate chemical disinfectant used Elaro ❑ 5 Decontamination/sanitation area separated and supplied ❑ Chemical riatel used: ® 6 Invoices and log kept for disposable, pre -sterilized equipment ❑ El25. Disinfectant used appropriately/sufficient contact time ❑ ® Sharps containers iners labeled, used, and disposed of ❑ Wet a ro riatel contact time provided: ❑ 8 Jewelry, tattoo and piercing equipment - clean and El® 26. Barriers used El ❑ 27 Products applied to skin are single use/dispensed ❑ PRACTITIONER HEALTH AND HYGIENE aseptically ❑ 9. No eating, drinking or smoking - clean clothes ❑ ® 28. Storage of inks, pigments, needles, tubes, etc. ❑ ❑ 10. Hands washed effectively and timely ❑ ❑ 29. Jewelry, Inks, Needles etc approved and used correctly ❑ ❑ 11. Handwashing facilities properly supplied and accessible, ❑ 1:130 Cross -contamination avoided during all phases of El water procedure ❑ 12. 1 Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES ❑ 13. Bloodborne Pathogen trainingEl❑ 31. Areas separated/no living or sleeping quarters F1 Source: ❑ 32. Floors and walls clean and in good repair, adequate light ❑ ❑ 14 Appropriate personal protective equipment available and ❑ ❑ 33 Workstation, surfaces, including chairs, armrests, etc. in ❑ used ood re air CUSTOMERS/CLIENTS ❑ 34. Perm it/registration posted ❑ ❑ 15. Branding is completed with no other customers in rocedure area ❑ ® 35. Operation and employee training records present El ❑ 16. Customers eighteen (18) years of age or older ❑ COMPLIANCE AND ENFORCEMENT ❑ 17. Skin adequately prepared for procedure ❑ ❑ 36. Plan(s) submitted for review ❑ ❑ 18 Client records approved and available - Consent form El El 37. Permits obtained and available El and uestionnaire ❑ 19. Appropriate aftercare instructions given to client ❑ ❑ 38. Impoundment ❑ MACHINE SAFETY AND SANITATION ❑ 39. Hearing scheduled ❑ ❑ 20. Safe machine design ❑ ❑ 40. Closure ❑ ❑ 21. Machines cleaned and disinfected between clients ❑ ❑ 41. ❑ Received b (Print): Daniel Hirschler Received by (Signature): hone: 209 623-7922 Specialist (Print): Benjamin Escotto, Sr REHS Specialist (Signature): + '�C� Phone: (209) 468-3178 if Reinspecion on/about: A reinspection fee of $130 per hour may be charged. Page 1 of 2 EH -03/2015