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U1" Body Art Ins ec� Re ort The above facility is inspected for compliance with Division V = Violation j Y P P Date: u IL is Q w: San Joaquin County Environmental Health Department Program C V 1868 E. Hazefton Ave., Stockton, CA 95205 Record: � S3� S3Z o P ` (209) 468-3420 Program g ❑ q<< www.siogv.org/ehd Element: ❑ Facility Name Address City Zip Code Wrong Side of the Tracks 512 n. union rd. Manteca 95337 Name of Permit/Registration Holder Permit Exp. Date Time In Time Out Inspection Type Aaron Brockman 6/30/15 Routine The above facility is inspected for compliance with Division V = Violation 104, Part C = 15, Chapter 7 of California Health and Safety Code (HSC). Corrected On Site V CLEANING AND STERILIZATION C V MACHINE SAFETY AND SANITATION cont.) C ❑ 1 Autoclave: approved and effective - passed integrator test ❑ ❑ 22. Parts replaced between clients - grommets, elastic bands, etc. ❑ ❑ 2 Items washed, disinfected, packaged, labeled, and sterilized ❑ PREVENTING CROSS -CONTAMINATION ❑ 3. Autoclave loaded correctly/packages allowed to dry ❑ ❑ 23. Workstation/procedure area decontaminated ❑ ❑ 4. Integrators used/monthly spore testflog maintained ❑ ❑ 24. Appropriate chemical disinfectant used ❑ ❑ 5 Decontamination/sanitation area separated and supplied appropriately ❑ Chemical used: ® 6 Invoices and log kept for disposable, pre -sterilized equipment ❑ ❑ 25. Disinfectant used appropriately/sufficient contact time ❑ ® 7 Sharps containers labeled, used, and disposed of appropriately ❑ Wet contact time provided: ® 8 Jewelry, tattoo and piercing equipment - clean and ❑ El 26. Barriers used E]sterilized HEALTH AND HYGIENE ❑ 27 Products applied to skin are single use/dispensed aseptically E]PRACTITIONER ❑ 9. No eating, drinking or smoking - clean clothes ❑ ❑ 28. Storage of inks, pigments, needles, tubes, etc. ❑ ❑ 10. Hands washed effectively and timely ❑ ❑29. Inks, Needles etc approved and used correctly El❑ 11 Handwashing facilities properly supplied and accessible, warm water El ❑ 30' Cross -contamination avoided during all phases of rocedure ElJewelry, ❑ 12. 1 Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES ® 13. Bloodborne Pathogen training❑ ❑ 31. Areas separated/no living or sleeping quarters E]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 good repair Elused CUSTOMERS/CLIENTS ® 34. Permit/registration posted ❑ ❑ 15. Branding is completed with no other customers in rocedure area ❑ ® 35. Operation and employee training records present ❑ ❑ 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 and uestionnaire ❑ ❑ 37. Permits obtained and available E] ® 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 by (Print): Aaron Brockman Received by (Signature): c Phone: (209) 406-7552 y!C! Specialist (Print): Benjamin Escotto, Sr REHS Specialist (Signature): C13t gAD Phone: (209) 468-3178 Reinspecion on/about: S/I u 1 1 S A reinspection fee of $130 per hour may be charged. Page 1 of 2 EH -03/2015