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This report is an Official Notice of Violation. Corrections must be completed in thy-t`im"pecified.
<br />A reinspection fee may be charged if violations noted on this report are not corrected by the reinspection date.
<br />Page I of Z_
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<br />_9A73
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<br />,o o Body Art Inspection Report Date(MWDDIYY)
<br />y County of San Joaquin County, Environmental Health Department
<br />1888 E. Hazelton Ave., Stockton CA 95205 Permit Number
<br />(209) 488-3420 www.sigov.oro/ehd
<br />Permit Type
<br />Name Address City Zip Code CT
<br />��Fjjacility
<br />_��\ 1/ \\ �9 q
<br />A)ir &A Ct J(& � -MG �GL � .ri 1 a N - UA i V - ild ii r 4c& -CA --xA a r A KIN
<br />Permlt/R istryya��tion Holder Name
<br />Permit
<br />Exp.
<br />Date
<br />Total Time Inspection Type
<br />�„V�tlt1 �Jr�LV-itC-ry
<br />RISK FACTORS
<br />AND
<br />INTERVENTIONS
<br />Risk factors are improper practices or procedures
<br />identified
<br />as contributing factors of cross -contamination.
<br />Interventions are control measures to prevent cross
<br />-contamination
<br />and transfer of pathogens from one person to another.
<br />In = in Compliance Out = Not in Compliance
<br />N/O
<br />= Not
<br />Observed
<br />N/A = Not Applicable COS = Corrected On Site
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<br />TT00 f1 INANE TCOOttdS CHI E°
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<br />r
<br />.,.,.
<br />EANING,SAND,STERI�IZATg ���? i *
<br />�itE.'rxis
<br />s
<br />SAEETIG D SA�d1TATI0N '
<br />CL' � ��
<br /># i
<br />In NIO
<br />1. Autoclave is approved and effective - passed
<br />In N/O
<br />18. Safe machine design
<br />❑
<br />❑
<br />❑
<br />❑
<br />NIA
<br />integrator test
<br />NIA
<br />In N/O
<br />2. Process of cleaning, labeling, packaging and
<br />in NIO
<br />19. Machines cleaned and disinfected between
<br />❑
<br />❑
<br />❑
<br />❑
<br />N/A
<br />stedifiing items correct)
<br />N/A
<br />clients
<br />In N/0
<br />3. Autoclave loaded correctly/packages allowed to
<br />In N/0
<br />20. Parts replaced between clients - grommets,
<br />❑
<br />❑
<br />❑
<br />❑
<br />NIA
<br />dry
<br />N/A
<br />elastic bands, etc.
<br />In NIO
<br />4. Integrators used/monthly sporetestllog
<br />❑
<br />❑
<br />�� , SEVEN (NGiCR{OSSaGQNTAMI�V1�Ti0N ;' #,
<br />;�
<br />N/A
<br />maintained:.r,ltv,:.�.:
<br />In NIO
<br />5. Decontamination/sanitation area separate and
<br />In NIO
<br />21. Workstation/procedure area decontaminated
<br />❑
<br />❑
<br />❑
<br />❑
<br />N/A
<br />supplied *
<br />NIA
<br />In NIO
<br />6. Invoices and log kept for disposable, pre-
<br />in N/0
<br />22. Chemical disinfectant used
<br />❑
<br />❑
<br />❑
<br />❑
<br />N/A
<br />sterilized equipment, backu supplies available *
<br />N/A
<br />Chemical used:
<br />In N/0
<br />7. Sharps containers supplied, labeled, used and
<br />In WO
<br />23. Disinfectant used sufficient contact time Wet
<br />❑
<br />❑
<br />❑
<br />❑
<br />NIA
<br />disposed of correct) *
<br />N/A
<br />contact timeprovided:
<br />In NIO
<br />8. Jewelry, tattoo and piercing equipment - storage
<br />In NIO
<br />24. Barriers available and used as part of
<br />❑
<br />❑
<br />❑
<br />❑
<br />N/A
<br />and use
<br />N/A
<br />procedure
<br />011
<br />a,#t��E,
<br />In N/0
<br />25. Products applied to skin are single
<br />❑
<br />❑
<br />PRA�TCfI��tik',AEALT1ffAND'.Fi�G11�t�E .. , a a . s.' x .
<br />' k :`
<br />�
<br />N/A
<br />use/dispensed ensed ase tical)
<br />In N/0
<br />9. No eating, drinking or smoking -clean clothes
<br />In N/0
<br />26. Storage of Inks, pigments, needles, tubes, etc.,
<br />❑
<br />❑
<br />I
<br />❑
<br />❑
<br />NIA
<br />NIA
<br />In N/0
<br />10. Hands washed effectively and timely
<br />in N/O
<br />27, Jewelry, Inks, Needles etc approved and used
<br />❑
<br />❑
<br />❑
<br />❑
<br />N/A
<br />NIA
<br />In N/0
<br />11. Handwashing facilities properly supplied and
<br />In N/0
<br />28. Cross -contamination avoided during all phases
<br />❑
<br />❑
<br />❑
<br />❑
<br />NIA
<br />accessible, warm potable water *
<br />NIA
<br />of procedure
<br />In N/O
<br />12. Personal protective equipment available and
<br />a#a
<br />BEST BI$INESS PRACTICES k
<br />N/A
<br />used, eyewash station available
<br />,,� ...
<br />� ,.,. .
<br />a
<br />i
<br />¢ r s
<br />Icut, OAt<E SVOL10115, � � i k
<br />�, wir
<br />�T ,t x
<br />in N/O
<br />29. Areas separated/no living or sleeping
<br />❑
<br />❑
<br />`
<br />NIA
<br />.
<br />m .&t,,#
<br />..
<br />quarters/no animals
<br />In N/O
<br />13. Branding is completed with no other customers in
<br />In N/0
<br />30. Floors and walls clean and in good repair,
<br />❑
<br />❑
<br />❑
<br />❑
<br />N/A
<br />procedure area
<br />N/A
<br />adequate light *
<br />In NIO
<br />14. Customers eighteen (18) years of age or older
<br />in NIO
<br />31. Workstation, surfaces, including chairs, , etc. in
<br />❑
<br />❑
<br />❑
<br />❑
<br />N/A
<br />N/A
<br />good repair, trash removed fre uentl
<br />In N/O
<br />15. Skin prepared for procedure.
<br />In N/O
<br />32. Permit/registration and required signs posted *
<br />❑
<br />❑
<br />❑
<br />❑
<br />N/A
<br />I
<br />NIA
<br />In N/0
<br />16. Client records available - Consent form &
<br />In NIO
<br />33. IPCP and employee training records and
<br />❑
<br />❑
<br />❑
<br />❑
<br />NIA
<br />questionnaire
<br />NIA
<br />Hepatitis B vaccination status present
<br />In N/O
<br />17. Aftercare instructions given to client
<br />in NIO
<br />34 Restrooms available, stocked *
<br />❑
<br />❑
<br />❑
<br />❑
<br />NIA
<br />I
<br />NIA
<br />This report is an Official Notice of Violation. Corrections must be completed in thy-t`im"pecified.
<br />A reinspection fee may be charged if violations noted on this report are not corrected by the reinspection date.
<br />Page I of Z_
<br />g??,5"'7
<br />_9A73
<br />
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