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Body Art Inspects Report Date: I1q I1$ <br /> �C San Joaquin County Environmental Health Department Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: P 20 S L3 y SZ <br /> (209)468-3420 <br /> www.siogv.org/ehd Program <br /> Element: 1412. <br /> Facility Name Address City Zip Code <br /> Canvas Tattoo 304 w.harding way#b Stockton 95204 <br /> Name of Permit/Registration Holder Permit Exp. Date Time In Time Out Inspection Type <br /> Melissa Santos 6/30/15 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 /> ® 1 Autoclave:approved and effective-passed integrator ❑ ❑ 22 Parts replaced between clients-grommets,elastic bands, ❑ <br /> test etc. <br /> ❑ <br /> Items washed,disinfected,packaged,labeled,and 2' sterilized El 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 ❑ <br /> ® 5' ❑ Chemical used: <br /> appropriately <br /> 6. <br /> ro riatel <br /> ® <br /> Invoices and log kept for disposable,pre-sterilized 6• ❑ ❑ 25. Disinfectant used appropriately/sufficient contact time <br /> equipment <br /> ElSharps containers labeled,used,and disposed of <br /> ® 7' Elappropriately <br /> [Wet contact time provided: <br /> Jewelry,tattoo and piercing equipment-clean and <br /> ❑ 8. El El26. Barriers used <br /> sterilized ❑ <br /> Products applied to skin are single use/dispensed <br /> PRACTITIONER HEALTH AND HYGIENE ❑ 27' 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 /> ® <br /> Handwashing facilities properly supplied and accessible, 30Cross-contamination avoided during all phases of 11. warm water ❑ ❑ . procedure ❑ <br /> ❑ 12. Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES <br /> ® 13. Bloodborne Pathogen training ® 31. 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 /> ❑ 14. used El ® 33' good repair El <br /> CUSTOMERS/CLIENTS ❑ 34. Permit/registration posted ❑ <br /> Branding is completed with no other customers in <br /> ❑ 15. rocedure area ❑ ® 35. Operation and employee training records present ❑ <br /> ❑ 16. Customers eighteen(18)years of age or older ❑ COMPLIANCE AND ENFORCEMENT <br /> ❑ 17. Skin adequately prepared for procedure ❑ ❑ 36. Plan(s)submitted for review ❑ <br /> Client records approved and available-Consent form <br /> ® 18. questionnaire <br /> El El 37. Permits obtained and available Eland <br /> ® 19. Appropriate aftercare instructions given to client ❑ ❑ 38. Impoundment ❑ <br /> MACHINE SAFETY AND SANITATION ❑ 39. Hearing scheduled ❑ <br /> ❑ 20. Safe machine design ❑ ❑ 40. Closure ❑ <br /> ❑ 21. Machines cleaned and disinfected between clients <br /> 01 <br /> El 41. El <br /> Received b (Print): Melissa Santos Received b (Signature 941-0875 <br /> Specialist(Print): Benjamin Escotto,Sr REHS Specialist(Signature): Phone: 209 468-3178 <br /> Reinspecion on/about: S hA 11S A reinspection fee of$130 per hour may be charged. Page 1 of 3 <br /> EH-03/2015 <br />