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U' c Body Art InspeA Report The above facility is inspected for compliance with Division V = Violation 104, Date: a San Joaquin County Environmental Health Department V 1868 E. Hazelton Ave., Stockton, CA 95205 Program ram V (209) 468-3420 C 4<;F0. www.siogv.org/ehd Program El❑ Element: Facility Name Address City Zip Code Canvas Tattoo 304 harding way Stockton 95204 Name of Permit/Registration Holder Permit Exp. Date Time In Time Out Inspection Type Melissa Santos 6/30/14 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 El❑ 22 Parts replaced between clients -grommets, elastic bands, etc. E]test ® 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 test/log maintained ❑ ❑ 24. Appropriate chemical disinfectant used Elappropriately ® 5 Decontamination/sanitation area separated and supplied El Chemical used: ® 6 Invoices and log kept for disposable, pre -sterilized equipment ❑ El25. Disinfectant used appropriately/sufficient contact time ❑ ❑ 7 Sharps containers labeled, used, and disposed of a ro riatel El Wet contact time provided: ❑ 8 Jewelry, tattoo and piercing equipment - clean and sterilized ❑ ® 26. Barriers used ❑ HEALTH AND HYGIENE ❑ 27 Products applied to skin are single use/dispensed ase tical) El ® 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 ❑ 30' Cross -contamination avoided during all phases of El ❑ 12. Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES ❑ 13. Bloodborne Pathogen training ❑ ❑ 31. Areas separated/no living or sleeping quarters ❑ Source: ❑ 32. Floors and walls clean and in good repair, adequate light ❑ ❑ 14 Appropriate personal protective equipment available and used ❑ ❑ 33 Workstation, surfaces, including chairs, armrests, etc. in good repair ❑ 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 ❑ ❑ 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 El F137. Permits obtained and available El ® 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 b (Print): Melissa Santos Received b (Signat Phone: G� /S Specialist (Print): Afonso Arambula Specialist (Signature): Phone: 209 468-9673 Reinspecion on/about: A reinspection fee of $125 per hour may EH -04/2014 Page 1 of 2