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q-5- Z o l 7 SIZ60 7787 ) Li10 j Facility Name Address City Zip Code Unioin Tattoo and Piercing 512 n. union road Manteca 95337 Name of Permit/Registration Holder Permit Exp. Date Time In Time Out Inspection Type Joshua P. Hughes 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 I Body Art Inspec Report C I San Joaquin County Environmental Health Department Date: �• n { 1868 E. Hazelton Ave., Stockton, CA 95205 Program Autoclave: approved and effective - passed integrator El Record: r= (209) 468-3420 Program r`P i' www.sioay.org/end Element: q-5- Z o l 7 SIZ60 7787 ) Li10 j Facility Name Address City Zip Code Unioin Tattoo and Piercing 512 n. union road Manteca 95337 Name of Permit/Registration Holder Permit Exp. Date Time In Time Out Inspection Type Joshua P. Hughes 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 I CLEANING AND STERILIZATION C I V I MACHINE SAFETY AND SANITATION (cont.) C ❑ 1 Autoclave: approved and effective - passed integrator El ❑ 22' Parts replaced between clients - grommets, elastic bands, etc. Eltest ❑ 2' Items washed, disinfected, packaged, labeled, and sterilized F1PREVENTING CROSS -CONTAMINATION ❑ 3. Autoclave loaded correctly/packages allowed to dry ❑ ❑ 23. Workstation/procedure area decontaminated ❑ ❑ 4. Integrators used/monthly spore test/log maintained ❑ ❑ 24. Appropriate chemical disinfectant used ❑ ❑ 5 Decontamination/sanitation area separated and supplied ro riatel appropriately ❑ Chemical used: Madacide ❑ 6. 6' Invoices and log kept for disposable, pre -sterilized equipment El El 25. Disinfectant used appropriately/sufficient contact time ElSharps El 7' containers labeled, used, and disposed of appropriately E]Wet contact time provided: 6 minutes ❑ 8 Jewelry, tattoo and piercing equipment - clean and sterilized ❑ ❑ 26. Barriers used ❑ HEALTH AND HYGIENE ❑ 27 Products applied to skin are single use/dispensed aseptically ElPRACTITIONER ❑ 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, warm water El F-1 30' Cross -contamination avoided during all phases of procedure E] ❑ 12. Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES ❑ 13. Bloodborne Pathogen trainingEl❑ 31. Areas separated/no living or sleeping quarters E] Source: ® 32. Floors and walls clean and in good repair, adequate light ❑ ❑ Appropriate personal protective equipment available and used El ❑ 33. Workstation, surfaces, including chairs, armrests, etc. in go repair E]14. CUSTOMERS/CLIENTS ❑ 34. Permit/registration posted ❑ ❑ 15. Branding is completed with no other customers in rocedure area El El 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 andquestionnaire El El37. Permits obtained and available ❑ ® 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 ❑ rEl 41. t ❑ Received b Print): Joshua P. Hughes Received by (Signature): hone: 209 825-5000 Specialist (Print): Har rit Mattu, Sr REHS Specialist (Signature): qotPhone: 209 468-3284 Reinspecion on/about: A reinspection fee of $130 per hour may be charged. Page 1 of 2 EH -03/2015