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ogTN- Date (MM/DD/YY) 0/1h <br />�ti <br />,o..•••••.•••:co Body Art Inspection Report <br />y County of San Joaquin County, Environmental Health Department <br />Permit Number <br />fry' 1868 E. Hazelton Ave., Stockton CA 95205 <br />(209) 468-3420 www.siaov.oro/ehd <br />_ Permit Type <br />Facility Name Addresscity Zip Code CT <br />Vj. A, Sy. MAA 533 3WJIA), <br />Perm�qgistraAn Holder Name Permit Exp. Date Total Time Inspection Type <br />Risk factors are improper practices or procedures identified as contributing factors of cross -contamination. <br />Interventions are control measures to prevent cross -contamination and transfer of pathogens from one person to another. <br />In = In Compliance Out = Not in Compliance <br />N/0 = Not <br />Observed <br />N/A = Not Applicable COS = Corrected On Site <br />TATTOO AND PERMANENT COSMETICS MACHINE <br />CLEANING AND STERILIZATION <br />..otfr"+ cos <br />SAFETY AND SANITATION':., <br />our cos <br />I <br />1. Autoclave is approved and effective -passed <br />to N/0 <br />18. Safe machine design <br />integrator test <br />N/A <br />In N/O <br />2. Process of cleaning, labeling, packaging and <br />0 <br />El <br />N/0 <br />19. Machines cleaned and disinfected between <br />0 <br />0 <br />A <br />sterliang items correct) <br />N/A <br />clients <br />In 10 <br />3. Autoclave loaded correctly/packages allowed to <br />0 <br />0 <br />In (V <br />20. Parts replaced between clients - grommets, <br />0 <br />0 <br />dry <br />WA <br />elastic bands, etc. <br />In N/0 <br />4. Integrators used/monthly spore test/log <br />PREVENTING CROSS -CONTAMINATION <br />NIA <br />maintained <br />0 <br />0 <br />g <br />In /O <br />5. Decontamination/sanitation area separate and <br />0 <br />0 <br />I N/0 <br />21. Workstation/procedure area decontaminated <br />0 <br />0 <br />NI <br />supplied * <br />N/A <br />In N10 <br />6. Invoices and log kept for disposable, pre- <br />� <br />N/0 <br />22. Chemical disinfectant used <br />N/A <br />sterilized equipment, backupsupplies available * <br />IA <br />Chemical used: fANA1_t1 <br />In N/0 <br />7. Sharps containers supplied, labeled, used and <br />0 <br />In N/0 <br />23. Disinfectant used sufficient contact time Wet <br />0 <br />0 <br />N/A <br />disposed of correct) * <br />/A <br />contact timeprovided: <br />In N10 <br />8. Jewelry, tattoo and piercing equipment - storage <br />0 <br />N/0 <br />24. Barriers available and used as part of <br />0 <br />0 <br />NIA <br />I and use <br />N/A <br />procedure <br />n01 <br />In N/0 <br />25. Products applied to skin are single <br />PRACTITIONER HEALTH AND HYGIEN ' ,' <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 />ia„t <br />�l <br />El <br />N! <br />N/A <br />In <br />10. Hands washed effectively and timely <br />0 0 <br />In N/0 <br />27. Jewelry, Inks, Needles etc approved and used <br />NIA <br />I <br />N/A <br />i WO <br />11. Handwashing facilities properly supplied and <br />0 <br />N/0 <br />28. Cross -contamination avoided during all phases <br />0 <br />0 <br />NIA <br />accessible, warm potable water * <br />N/A <br />of procedure <br />In N10 <br />12. Personal protective equipment available and <br />0 0 <br />r BEST.BUSINI~SSi 10ES''• <br />NIA <br />used, eyewash station available * <br />0MERSICLIENTS <br />I N/0 <br />29. Areas separated/no living or sleeping <br />0 <br />0 <br />_ <br />N/A <br />quaIrtarstno animals <br />In <br />13. Branding is completed with no other customers in <br />0 0 <br />In N/0 <br />30. Floors and walls clean and in good repair, <br />0 <br />procedure area <br />/A <br />adequate light * <br />In N10 <br />14. Customers eighteen (18) years of age or older <br />0 0 <br />N/O <br />31. Workstation, surfaces, including chairs, , etc. in <br />❑ <br />0 <br />N/A <br />good repair; trash removed frequently <br />In <0 <br />15. Skin prepared for procedure. <br />0 0 <br />NIO <br />32. Permit/registration and required signs posted * <br />0 <br />0 <br />N/A <br />N/A <br />In N/0 <br />16. Client records available - Consent form & <br />9� 0 <br />In N/0 <br />33. IPCP and employee training records and <br />0 <br />N/A <br />questionnaire <br />N/A <br />Hepatitis B vaccination status present <br />In N/0 <br />17. Aftercare instructions given to client <br />0 <br />In N/0 <br />34 Restrooms available, stocked * <br />❑ <br />❑ <br />N/A <br />NIA <br />Received <br />Specialist Print : AMjl\ - 5 Specialist (Signature): <br />This report is an Official Notice of Violation. Corrections must be completed in the time specified. <br />A reinspection fee may be charged if violations noted on this report are not corrected by the reinspection date. <br />Pagel of 3 <br />Phone: <br />Reinspection Date (on or about) <br />