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<br />Body Art Inspeon Report' 2 San Joaquin County Environmental Health Department
<br />1868 E. Hazelton Ave., Stockton, CA 95205
<br />(209) 468-3420
<br />"+ ''•'•• d 'A`p' • www.siogv.org/ehd
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<br />Date: �a%5� Is
<br />Program �n � Li M�1
<br />Record: , ` J
<br />Program
<br />Element:
<br />Facility Name Address City Zip Code
<br />Gypsy Soul Tattoo 118 yosemite ave. Manteca 95336
<br />Name of Permit/Registration Holder Permit Exp. Date Time In Time Out Inspection Type
<br />John Holguin 6/30/15 Routine
<br />�❑
<br />2r
<br />The above facility is inspected for compliance with Division
<br />104,
<br />❑
<br />Part 15,
<br />Chapter 7 of California Health and Safety Code (HSC).
<br />❑
<br />❑
<br />z8.
<br />V = Violation
<br />El
<br />❑
<br />C =
<br />Corrected On Site
<br />❑�
<br />V
<br />CLEANING
<br />AND STERILIZATION
<br />C
<br />V
<br />MACHINE SAFETY AND SANITATION cont.
<br />C
<br />❑
<br />1
<br />Autoclave: approved and effective - passed integrator
<br />❑
<br />❑
<br />22
<br />Parts replaced between clients - grommets, elastic bands,
<br />❑
<br />❑
<br />test
<br />❑
<br />13-
<br />Bloodborne Paftgen train,
<br />Source:
<br />etc.
<br />❑
<br />❑
<br />2'
<br />Items washed, disinfected, packaged, labeled, and
<br />El
<br />I ❑
<br />32.
<br />Floors and walls clean and in good repair, adequate light
<br />El 1
<br />❑
<br />sterilized
<br />Appropriate personal protective equipment avai.l.ablp and
<br />used
<br />El
<br />CROSS -CONTAMINATION
<br />' ! rk t.otinr,suraces including chair
<br />s, armrests, in
<br />good repair
<br />❑
<br />3.
<br />Autoclave loaded correctly/packages allowed to dry
<br />❑
<br />❑
<br />23.
<br />Workstation/procedure area decontaminated
<br />❑
<br />❑
<br />4.
<br />Integrators used/monthly spore testilog maintained❑
<br />I El
<br />❑
<br />24.
<br />Appropriate chemical disinfectant used
<br />❑
<br />❑
<br />5.
<br />Decontamination/sanitation area separated and supplied
<br />❑�
<br />COMPLIANCE AND ENFORCEMENT
<br />_,..c.�.i`:ai used:
<br />Eli7.
<br />I appropriate)
<br />E]
<br />E]36.
<br />Plans) submitted for review
<br />❑'I
<br />®
<br />6.
<br />Invoices and log kept for disposable, pre -sterilized
<br />❑,
<br />❑
<br />�
<br />25
<br />fect r fF t , c! r
<br />Ci.,in,�r•.an. used apprcpriately,su,=cie;=.. ^ sta.�, .n,e
<br />®
<br />19.
<br />Appropriate aftercare instructions given to client
<br />equipment
<br />I ❑
<br />1 38.
<br />j�
<br />( ❑
<br />❑
<br />❑
<br />V
<br />Sharps containers labeled, used, and disposed of
<br />Hearing scheduled
<br />C€csure
<br />❑
<br />❑
<br />❑
<br />❑
<br />7
<br />❑:
<br />❑
<br />21.
<br />Machines cleaned and disinfected between clients
<br />i
<br />+ t ±•rn
<br />Wet contact .i.,.e provided:
<br />( 41.
<br />❑
<br />appropriately
<br />Reinspecion oniabout. A reinspection fee of li13u per Pour may be charaetd. Nage i of 2
<br />EH -03/2015
<br />❑
<br />8
<br />Jewelry, tattoo and piercing equipment - clean and
<br />sterilized
<br />❑
<br />®
<br />26.
<br />i Barriers used
<br />� ❑
<br />PRACTITIONER HEALTH AND HYGIENE_
<br />I
<br />�❑
<br />2r
<br />Prgducts applied to skin are single use/dispensed
<br />El
<br />❑
<br />9.
<br />_ v
<br />leo eating, drinking or s:.aking - cleat; clothes
<br />❑
<br />❑
<br />z8.
<br />S.erage of inks, pigments, needles, tubes, etc.
<br />El
<br />❑
<br />10.
<br />Hands washed effectively and timely
<br />❑�
<br />❑
<br />jj'
<br />129
<br />Jewelry, Inks, Needles etc approved and _:sed r_rrectly
<br />j ❑
<br />®
<br />11.
<br />Handwashing facilities properly supplied and accessible,
<br />warm water
<br />❑
<br />❑
<br />30.
<br />Cress -contamination. avoided ;luring all phases of
<br />procedure
<br />❑
<br />❑
<br />12.
<br />Hepatitis B vaccination
<br />❑
<br />BEST BUSINESS PRACTICES
<br />❑
<br />13-
<br />Bloodborne Paftgen train,
<br />Source:
<br />❑
<br />❑
<br />31.
<br />Areas separated/no living or sleeping q esters
<br />❑
<br />I ❑
<br />32.
<br />Floors and walls clean and in good repair, adequate light
<br />El 1
<br />❑
<br />14.
<br />Appropriate personal protective equipment avai.l.ablp and
<br />used
<br />El
<br />33.
<br />' ! rk t.otinr,suraces including chair
<br />s, armrests, in
<br />good repair
<br />I ❑
<br />CUSTOMERS/CLIENTS
<br />❑
<br />34
<br />Permit'legistratiOn posted
<br />❑
<br />❑
<br />18
<br />I Branding is completed with no other customers in
<br />procedure area
<br />I El
<br />®
<br />3�-
<br />Operation andemployeeplayeP +r _.arninn records nreeent,
<br />�❑
<br />❑
<br />16.
<br />Customers eighteen (18) years of age or older
<br />❑�
<br />COMPLIANCE AND ENFORCEMENT
<br />Eli7.
<br />Skin adequately prepared for procedure
<br />E]
<br />E]36.
<br />Plans) submitted for review
<br />❑'I
<br />1°.
<br />Client records approved and available - Consent form
<br />and questionnaire
<br />❑❑
<br />37.
<br />Pen,'its obtained and available
<br />❑
<br />®
<br />19.
<br />Appropriate aftercare instructions given to client
<br />Ell
<br />I ❑
<br />1 38.
<br />Impoundment
<br />( ❑
<br />MACHINE SAFETY AND SANITATION
<br />❑
<br />V
<br />39.
<br />' J.
<br />Hearing scheduled
<br />C€csure
<br />❑
<br />❑
<br />❑
<br />_0.
<br />Si=re mach€r;e desig^
<br />❑:
<br />1 ❑
<br />21.
<br />Machines cleaned and disinfected between clients
<br />El
<br />EJ
<br />( 41.
<br />❑
<br />Received by (Print): John. Holgui€, Received by (Signature): Phone: (209) 239-0800
<br />Specialist (Print). Benjamin Escoito. Sr REH5 Specialist (Sign tura', _Phone: (209) 4688'-3178
<br />Reinspecion oniabout. A reinspection fee of li13u per Pour may be charaetd. Nage i of 2
<br />EH -03/2015
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