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ra Body Art Inspe&n Report Date: qhl S <br /> San Joaquin County Environmental Health Department ProgramT� r <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 <br /> Record: <br /> rd: fto 53,7 t0 <br /> (209)468-3420 Program <br /> www.siogv.org/ehd <br /> Element: <br /> Facility Name Address City Zip Code <br /> Ink City Tattoo 3008 e.hammer lane,suite 124 Stockton 95212 <br /> Name of Permit/Registration Holder Permit Exp.Date Time In Time Out Inspection Type <br /> Phillip Mendoza 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 integrator1-1 ❑ 7Parts replaced between clients-grommets,elastic bands, Eltest etc. <br /> Items washed,disinfected,packaged,labeled,and <br /> El 2. sterilized E] PREVENTING 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 ❑ [1 24. Appropriate chemical disinfectant used <br /> ❑ 5 Decontamination/sanitation area separated and supplied ❑ <br /> ❑ Chemical used: <br /> appropriately <br /> ® 6 Invoices and log kept for disposable,pre-sterilized <br /> equipment F1 25. Disinfectant used appropriately/sufficient contact time <br /> ® 7 Sharps containers labeled,used,and disposed of ❑ <br /> ElWet contact time provided: <br /> appropriately <br /> ❑ 8 Jewelry,tattoo and piercing equipment-clean and <br /> sterilized El 26. Barriers used El <br /> ® 27 Products applied to skin are single use/dispensed E]PRACTITIONER HEALTH AND HYGIENE aseptically <br /> ❑ 9. No eating,drinking or smoking-clean clothes [I ❑ 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 /> ® 11. Handwashing facilities properly supplied and accessible, Cross-contamination avoided during all phases of ❑ <br /> warm water El El 30. 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 /> ❑ 14. Appropriate personal protective equipment available and 0I El Workstation,surfaces,including chairs,armrests,etc.in E]usedgood repair <br /> CUSTOMERS/CLIENTS ❑ 34. Permittregistration posted ❑ <br /> ❑ 15. Branding is completed with no other customers in <br /> rocedure area El ® 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 /> ® 18 Client records approved and available-Consent form <br /> and uestionnaire El El 37. Permits obtained and available El <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 ❑l 1 ❑ 41. E] <br /> Received by(Print): Ruben Benites Received by(Signature): one: 209 932-9372 <br /> Specialist(Print): Benjamin Escotto,Sr REHS Specialist(Signature): A,. Phone: 209 468-3178 <br /> Reinspecion on/about: SlZ3(15 A reinspection fee of$130 per hour may be charged. Page 1 of 3 <br /> EH-03/2015 <br />