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�0. Uip>_.�A l Body Art InspecA Report Date: I jghs 10. V MACHINE SAFETY AND SANITATION (cont. El 1' San Joaquin County Environmental Health Department Program ❑ _ 1868 E. Hazelton Ave., Stockton, CA 95205 Record: 2. �q (209) 468-3420 Program CROSS -CONTAMINATION •:..:....•gyp'' coed'' www.siogv.org/ehd Element: 1.103 "l Facility Name Address City Zip Code Gypsy Soul Tattoo 118 yosemite ave. Manteca 95336 Name of Permit/Registration Holder Permit Exp. Date Time In Time Out Inspection Type John Holguin Decontamination/sanitation area separated and supplied ro riatel appropriately ElChemical Final Consult. 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 Invoices and log kept for disposable, pre -sterilized equipment ❑ V CLEANING AND STERILIZATION C 10. V MACHINE SAFETY AND SANITATION (cont. El 1' Autoclave: approved and effective - passed integrator test ❑ ❑ 22' Parts replaced between clients - grommets, elastic bands, etc. ❑ 2. Items washed, disinfected, packaged, labeled, and sterilized El ❑ 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 ❑ 5' Decontamination/sanitation area separated and supplied ro riatel appropriately ElChemical used: ❑ 6. 6' Invoices and log kept for disposable, pre -sterilized equipment ❑ ❑ 25. Disinfectant used appropriately/sufficient contact time ❑ 7. Sharps containers labeled, used, and disposed of appropriately El [Wet contact time provided: ❑ 8. Jewelry, tattoo and piercing equipment - clean and ❑ ❑ 26. Barriers used ❑ 9. No eating, drinking or smoking - clean clothes ❑ 10. Hands washed effectively and timely ❑ 11. Handwashing facilities properly supplied and accessible, warm water ❑ 12. Hepatitis B vaccination ❑ 13. Bloodborne Pathogen training ❑ ❑ Source: ❑ 14 Appropriate personal protective equipment available and used ❑ CUSTOMERS/CLIENTS ❑ 15. Branding is completed with no other customers in procedure area ❑ 16. Customers eighteen (18) years of age or older ❑ 17. Skin adequately prepared for procedure ❑ 18 Client records approved and available - Consent form and questionnaire ❑ 19. Appropriate aftercare instructions given to client MACHINE SAFETY AND SANITATION ❑ 20. Safe machine design ❑ 21. Machines cleaned and disinfected between clients ❑ 31. Areas separated/no living or sleeping quarters ❑ ❑ 32. Floors and walls clean and in good repair, adequate light ❑ 27 Products applied to skin are single use/dispensed aseptically ❑ ❑ ❑ 28. Storage of inks, pigments, needles, tubes, etc. ❑ ❑ ❑ 29. Jewelry, Inks, Needles etc approved and used correctly ❑ ❑ ❑ 30. Cross -contamination avoided during all phases of procedure ❑ ❑ 40. RCCT RI IQIU=CC DDAf"T1L`CC ❑ 31. Areas separated/no living or sleeping quarters ❑ ❑ 32. Floors and walls clean and in good repair, adequate light ❑ ❑ 33. Workstation, surfaces, including chairs, armrests, etc. in good repair ❑ ❑ 34. Permit/registration posted ❑ ❑ 35. 1 Operation and employee training records present ❑ '-'I COMPLIANCE AND ENFORCEMENT ❑ ❑ 36. Plan(s) submitted for review ❑ ❑ 37. Permits obtained and available ❑ ❑ 38. Impoundment ❑ 39. Hearing scheduled ❑ ❑ 40. Closure 01 ❑ 41. Received b (Print): John Holguin Received b (Signature): Phone: 209 239-0800 Specialist (Print): Benjamin Escotto, Sr REHS Specialist (Signature): Phone: (209) 468-3178 Reinspecion on/about: A reinspection fee of $130 per hour may be charged. Page 1 of 2 EH -03/2015