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Name of Permit/Registration Holder Permit Exp. Date Time In Time Out Inspection Type Daniel Hirschler Initial Consult. 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 ❑ ❑ 22 Parts replaced between clients - grommets, elastic bands, Eltest etc. E] 2' Items washed, disinfected, packaged, labeled, and sterilized El ❑ Body Art Ins eco Report . Lt1l7((S ❑ 4. Date: ❑ El San Joaquin County Environmental Health Department Program 11appropriately ® 1868 E. Hazelton Ave., Stockton, CA 95205 Record: c V-00� 1145 �I (209) 468-3420 www.siogv.org/ehd Program 1� ,^yl ❑ 8 Element: `� Facility Name Address City Zip Code Teleios Tattoo Studio 3414 delaware ave. Stockton 95204 Name of Permit/Registration Holder Permit Exp. Date Time In Time Out Inspection Type Daniel Hirschler Initial Consult. 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 ❑ ❑ 22 Parts replaced between clients - grommets, elastic bands, Eltest etc. E] 2' Items washed, disinfected, packaged, labeled, and sterilized El ❑ 3. Autoclave loaded correctly/packages allowed to dry ❑ ❑ 4. Integrators used/monthly spore test/log maintained ❑ El 5 Decontamination/sanitation area separated and supplied 11appropriately ® 6 Invoices and log kept for disposable, pre -sterilized equipment ❑ ❑ 7 Sharps containers labeled, used, and disposed of appropriately ❑ ❑ 8 11 Jewelry, tattoo and piercing equipment - clean and ❑ PRACTITIONER HEALTH AND HYGIENE ❑ 9. No eating, drinking or smoking - clean clothes ❑ ❑ 10. Hands washed effectively and timely ❑ ❑ 11 Handwashing facilities properly supplied and accessible, warm water ❑ ❑ 12. Hepatitis B vaccination ❑ ® 13. Bloodborne Pathogen training ❑ ❑ 29. Source: ❑ ❑ 14 Appropriate personal protective equipment available and used ❑ ❑ 1 15 Branding is completed with no other customers in procedure area ❑ ❑ 16. Customers eighteen (18) years of age or older ❑ ❑ 17. Skin adequately prepared for procedure ❑ ® 18. Client records approved and available - Consent form questionnaire Eland ® 19. Appropriate aftercare instructions given to client ❑ MACHINE SAFETY AND SANITATION ❑ 20. Safe machine design ❑ ❑ 21. Machines cleaned and disinfected between clients ❑ Received by (Print): Daniel Hirschler Received b Specialist (Print): Beniamin Escotto. Sr REHS Specialist (S PREVENTING CROSS -CONTAMINATION ❑ 1 23. 1 Workstation/procedure area decontaminated ❑ ❑ 24. Appropriate chemical disinfectant used Chemical used: El ❑ 25. Disinfectant used appropriately/sufficient contact time ❑ ❑ 32. Wet contact time provided: El ❑ 26. Barriers used ❑ ❑ 27 Products applied to skin are single use/dispensed aseptically ❑ ❑ 28. Storage of inks, pigments, needles, tubes, etc. ❑ ❑ 29. Jewelry, Inks, Needles etc approved and used correctly ❑ ❑ 30. Cross -contamination avoided during all phases of ..... ❑ BEST BUSINESS PRACTICES ❑ 1 31. Areas separated/no living or sleeping quarters ❑ ❑ 32. Floors and walls clean and in good repair, adequate light ❑ ❑ 33. Workstation, surfaces, including chairs, armrests, etc. in good repair ❑ ® 34. Permit/registration posted ❑ ❑ 35. Operation and employee training records present ❑ COMPLIANCE AND ENFORCEMENT ❑ 36. 1 Plan(s) submitted for review ❑ ® 37. Permits obtained and available ❑ ❑ 38. Impoundment ❑ ❑ 39. Hearing scheduled ❑ ❑ 40. Closure ❑ ❑ 41. ❑ nature - (L).Xl— Phone: 209 623-7922 iture : Phone: 209 468-3178 Reinspecion on/about: A reinspection fee of $130 per hour may be charged. Page 1 of 2 EH -03/2015