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-404 �0�v <br /> Bod Art Ins ection Re orty p p Date: November 15, 2021 <br /> NSan Joaquin County Environmental Health Department Program <br /> 1868 E.Hazelton Ave., Stockton,CA 95205 Record: PR0541621 <br /> (209)468-3420• w .sioov.oro/ehd Program <br /> \(F OR% Element: 4120 <br /> Facility Name Address City Zip Code <br /> Versailles Salon 1010 N Central Ave. Tracy 95376 <br /> Name of Permit/Registration Holder Permit Exp. Date Time In Time Out Inspection Type <br /> Erica Green-Ffese 6/30/22 Routine <br /> The above facility is inspected for compliance with Division 104, Part 15, Chapter 7 of California Health and Safety Code (HSC). <br /> V=Violation C = Corrected On Site <br /> V CLEANING AND STERILIZATION C V MACHINE SAFETY AND SANITATION Cont. C <br /> El1. Autoclave: approved and effective-passed Integrator test El El22 Parts replaced between clients -grommets, elastic bands, Eletc. <br /> El 2. Items washed, disinfected, packaged, labeled, and <br /> sterilized ❑ PREVENTING CROSS-CONTAMINATION <br /> ❑ 3. Autoclave loaded correctly/packages allowed to dry ❑ ❑ 23. Workstation/procedure area decontaminated ❑ <br /> ❑ 4. Integrators used/monthly spore test/log maintained ❑ 24. Appropriate chemical disinfectant used <br /> Decontamination/sanitation area separated and supplied El El <br /> ❑ 5' appro riatel ❑ Chemical used: <br /> Invoices and log kept for disposable,pre-sterilized <br /> ® 6. ❑ ❑ 25. Disinfectant used appropriately/sufficient contact time Elappropriately <br /> e ui meni <br /> Sharps containers labeled, used, and disposed of <br /> ❑ TEl Wet contact time provided: <br /> ❑ 8 Jewelry, tattoo and piercing equipment-clean and ❑ ❑ 26. Barriers used ❑ <br /> sterilized <br /> PRACTITIONER HEALTH AND HYGIENE ❑ 27. Products applied to skin are single use/dispensed aseptically ❑ <br /> ❑ 9. No eating, drinking or smoking - clean clothes ❑ ❑ 28. Storage of inks, pigments, needles, tubes, etc. ❑ <br /> ❑ 10. Hands washed effectively and timely ❑ ❑ 29. Jewelry, Inks, Needles etc approved and used correctly ❑ <br /> Handwashing facilities properly supplied and accessible, <br /> El 11' warm water El ❑ 30. Cross-contamination avoided during all phases of procedure El <br /> ❑ 12. Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES <br /> El El <br /> Bloodborne Pathogen training ElElEl31. Areas separated/no living or sleeping quarters <br /> Source: 32. Floors and walls clean and in good repair, adequate light ❑ <br /> Appropriate personal protective equipment available and Workstation, surfaces, including chairs, armrests, etc. in <br /> El 14. used - El ❑ 33. good repair ❑ <br /> CUSTOMERS/CLIENTS ❑ 34. Permittregistralion posted ❑ <br /> Branding is completed with no other customers in <br /> El 15. rocedure area El El35. Operation and employee training records present El <br /> ❑ 16. Customers eighteen (18)years of age or older ❑ COMPLIANCE AND ENFORCEMENT <br /> El17. Skin adequately prepared for procedure ❑ ❑ 36. Plan(s) submitted for review ❑ <br /> Client records approved and available -Consent form and <br /> ❑ 18. El El37. Permits obtained and available Eluestionnaire <br /> ❑ 19. Appropriate aftercare instructions given to client ❑ ❑ 38. Impoundment ❑ <br /> MACHINE SAFETY AND SANITATION ❑ 39. Hearing scheduled ❑ <br /> El 20. Safe machine design ❑ ❑ 40. Closure ❑ <br /> ❑ 21. I Machines cleaned and disinfected between clients ❑ ❑ 41. ❑ <br /> Received by(Print): Erica Green-Frese Received by(Signature): Emailed Phone: 209-275-9133 <br /> Specialist(Print): Sandip Singh Specialist(Signature): J¢�y�j�,d� aay li Phone: 209-468-3526 <br /> Reinspection on/about: A reinspection fee of$152 per hour may be charged. Page 1 of 2 <br /> EH-11/17 <br />