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Body Art Inspeck Repot 0 Date: �Gx\, San Joaquin County Environmental Health Department Program 1868 E. Hazelton Ave., Stockton, CA 95205 Record: e2oS3'7kZ� (209) 468-3420 Program •` ,q ;; �` www.siogv.org/ehd CicoF Element: Facility Name Address City Zip Code Lucky You Tattoo 181 w alameda st Manteca 95336 Name of Permit/Registration Holder Permit Exp. Date Time In Time Out Inspection Type John Holguin 6/30/14 Routine The above facility is inspected for compliance with Division 104, Part 15, Chapter 7 of California Health and Safety Code (HSC). V = Violation C = Corrected On Site V CLEANING AND STERILIZATION C V MACHINE SAFETY AND SANITATION cont.) C ❑ 1 Autoclave: approved and effective - passed integrator ❑ E]22. Parts replaced between clients - grommets, elastic bands, ❑ test etc. ❑ 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 usedimonthly spore test/log maintained ❑ ❑ 24. Appropriate chemical disinfectant used Ellappropriately ❑ 5 Decontamination/sanitation area separated and supplied El Chemical used: ® 6. Invoices and log kept for disposable, pre-sterilized ❑ E]25. Disinfectant used appropriately/sufficient contact time equipment 117 ® Sharps containers labeled, used, and disposed of F1 Wet contact time provided: a ro riatel ❑ 8 Jewelry, tattoo and piercing equipment - clean and El 26. Barriers used ❑ sterilized ❑ 27 Products applied to skin are single use/dispensed ElPRACTITIONER HEALTH AND HYGIENE ase tical) ❑ 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, El ❑ 30 Cross-contamination avoided during all phases of El. warm water procedure ❑ 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 ❑® 33 Workstation, surfaces, including chairs, armrests, etc. in Elused good repair CUSTOMERSICLIENTS ® 34. Permit/registration posted ❑ ❑ 15. Branding is completed with no other customers in ❑ El 35. Operation and employee training records present El rocedure area ❑ 16. Customers eighteen (18) years of age or older ❑ I COMPLIANCE AND ENFORCEMENT ❑ 17. Skin adequately prepared for procedure ❑ ❑ 36. Plan(s) submitted for review ❑ ® 18 Client records approved and available - Consent form El El 37. Permits obtained and available ❑ and questionnaire ® 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): 6ffKIS r'0*&CS�1Wt/ Received by (Signature): Phone: Z07- T!Pyl Specialist (Print): Benjamin Escotto Specialist (Signature): ey Phone: (209) 468-3178 Reinspecion on/about: A reinspection fee of $125 per hour may charged. Page 1 of 2 EH -04/2014