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Page 11 of ILt <br />,o� qUl Body Art Inspection Report <br />Date (MM/DD/YY) <br />_ <br />at <br />y County of San Joaquin County, Environmental Health Department <br />Permit Number <br />1868 E. Hazelton Ave., Stockton CA 95205 <br />+•) (209) 468-3420 www.sigov.org/ehd <br />� <br />f <br />Permit Type yr -1 1 <br />�4j F p"Rl�r <br />Facility Name <br />Address <br />city Zip Code CT <br />ci7m'�t> <br />Viftir_�'S) <br />q _,c%Yl ,_)f)L*,t]If).— <br />PermittRegistration Holder Name <br />Pe it Exp. Date Total Time Inspection Type�r <br />RISK FACTORS AND INTERVENTIONS <br />Risk factors are improper practices or procedures identified <br />as contributing factors of cross -contamination. <br />Interventions are control measures to prevent cross -contamination <br />and transfer of pathogens from one person to another. <br />In = In Compliance Out = Not in Compliance <br />N/O = Not <br />Observed <br />N/A <br />= Not Applicable COS = Corrected On Site <br />TATTOO AND PERMANENT COSMETICR MACHINE <br />CLEANING AND STERILIZATION <br />our' cos <br />SAFETY ANDSANRATI(3N <br />our cos <br />In 10 <br />1. Autoclave is approved and effective - passed <br />-0 <br />In N/0 <br />18. Safe machine design <br />/A <br />int rator test <br />NIA <br />1 N/0 <br />2. Process of cleaning, labeling, packaging and <br />❑ <br />13 <br />In N/0 <br />19. Machines cleaned and disinfected between <br />/A <br />sterlizilng items correctly <br />NIA <br />clients <br />11 <br />0 <br />In WO <br />3. Autoclave loaded correctly/packages allowed to <br />❑ <br />CI <br />In N/0 <br />20. Parts replaced between clients - grommets, <br />0 <br />0 <br />/A <br />dry <br />N/A <br />I elastic bands, etc. <br />In N/0 <br />4. Integrators used/monthly spore tesMog <br />PREVEN I G G OSS -CONTAMINATION, <br />/A <br />maintained <br />In N/0 <br />5. Decontamination/sanitation area separate and <br />11 <br />11 <br />In N/0 <br />21. Workstation/procedure area decontaminated <br />❑ <br />❑ <br />NIA <br />su lied * <br />N/A <br />In N/0 <br />6, Invoices and log kept for disposable, pre- <br />0 <br />11 <br />In N/0 <br />22. Chemical disinfectant used <br />0 <br />U <br />sterilized equipment, backu supplies available * <br />N/A <br />Chemical used: <br />In/0 <br />7. Sharps containers supplied, labeled, used and <br />In N/0 <br />23. Disinfectant used sufficient contact time Wet <br />13 <br />11 <br />NIA <br />disposed of correct) * <br />N/A <br />contact timeprovided: <br />In NIO <br />8. Jewelry, tattoo and piercing equipment — storage <br />0 <br />0 <br />In N10 <br />24. Barriers available and used as part of <br />EI <br />13 <br />NIA <br />and use <br />N/A <br />procedure <br />In N/0 <br />25. Products applied to skin are single <br />PRACTITIONER HEALTH ANQ HYGOE <br />N/A <br />useldis ensed ase tical) <br />InNNIO <br />9, No eating, drinking or smoking - clean clothes <br />In N/O <br />26. Storage of inks, pigments, needles, tubes, etc., <br />lA <br />NIA <br />In N/0 <br />10. Hands washed effectively and timely <br />17 <br />O <br />In N/0 <br />27. Jewelry, Inks, Needles etc approved and used <br />0 <br />11 <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 />NIA <br />accessible, warm potable water * <br />NIA <br />of procedure <br />In N/O <br />12. Personal protective equipment available and <br />4 "fR <br />91=ST US!SS PRACTICES ; <br />NIA <br />used, eyewash station available <br />s <br />CUSTOMERSIGLIENTS <br />In N/0 <br />29. Areas separated/no living or sleeping <br />�. <br />IAquarters/no <br />animals <br />In N/0 <br />13. Branding is completed with no other customers in <br />0 <br />0 <br />I NIO <br />30. Floors and walls clean and in good repair, <br />0 <br />❑ <br />NIA <br />procedure area <br />/A <br />adequate light * <br />In N/O <br />14. Customers eighteen (18) years of age or older <br />❑NIO <br />31. Workstation, surfaces, including chairs, , etc. in <br />0 <br />N/A <br />NIA <br />good repair; trash removed frequently * <br />In N/0 <br />15. Skin prepared for procedure, <br />11 <br />0 <br />In N/0 <br />32. Permit/registration and required signs posted <br />11 <br />0 <br />NIA <br />IA <br />I N/O <br />16. Client records available - Consent form & <br />0 <br />13 <br />I N/0 <br />33. IPCP and employee training records and <br />0 <br />0 <br />/A <br />questionnaire <br />N/A <br />He atitiis B vaccination status present <br />ly N/0 <br />17. Aftercare instructions given to client <br />In N/0 <br />34 Restrooms available, stocked * <br />11 <br />0 <br />NIA <br />N/A <br />Received by <br />(Print): Received by (Signature): <br />Phone: <br />Specialist (Print): Specialist (Signature): <br />Phone: <br />❑This report is an Official Notice of Violation. Corrections must <br />be completed in the time specified. <br />A reinspection fee maybe charged if violations noted on this report are not corrected by the reinspection date. Reinspection Date (on or about) <br />Page 11 of ILt <br />