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Body Art {nspelkn Report Date: 3/2 -/Id' s San Joaquin County Environmental Health Department Program " 1868 E. Hazelton Ave., Stockton, CA 95205 Record: I p5(4 10:50 (209) 468-3420 Program oq�IFoaa�P www.siogv.org/ehd Element: 4120 Facility Name Address City Zip Code Forsaken Tattoo 13500 hwy 88 Lockeford 95237 Name of Permit/Registration Holder Permit Exp. Date Time In Time Out Inspection Type Tony Henson 6/30/18 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 E ❑ 1 Autoclave: approved and effective - passed integrator ❑ ❑ 22 I Parts replaced between clients - grommets, elastic bands, test etc. El 2' Items washed, disinfected, packaged, labeled, and 11PREVENTING sterilized 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 [ El 5" Decontamination/sanitation area separated and supplied El Chemical used: HB Sani-Cloth appropriately ❑ 6' Invoices and log kept for disposable, pre -sterilized El❑ 25. Disinfectant used appropriately/sufficient contact time equipment El 7" Sharps containers labeled, used, and disposed of El Wet contact time provided: 3 min appropriately [ El Jewelry, tattoo and piercing equipment - clean and El El 26. Barriers used sterilized F1 27. Products applied to skin are single use/dispensed PRACTITIONER HEALTH AND HYGIENE aseptically[ [ [ [ ❑ 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, ❑ ❑ 30 Cross -contamination avoided during all phases of warm water procedure [ ❑ 12. Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES ❑ 13. Bloodborne Pathogen trainingElEl31. Areas separated/no living or sleeping quarters [ [ Source: Cathy Montie, Biologix ❑ 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 used good repair [ ❑ 34. Permit/registration posted CUSTOMERS/CLIENTS [ ❑ 15. Branding is completed with no other customers in ❑ ❑ 35. Operation and employee training records present procedure area [ [ ❑ 16. Customers eighteen (18) years of age or older ❑ COMPLIANCE AND ENFORCEMENT ❑ 17. Skin adequately prepared for procedure ❑ ❑ 36. Plan(s) submitted for review El 18. Client records approved and available - Consent form El [:137. Permits obtained and available and uestionnaire [ [ ❑ 19. Appropriate aftercare instructions given to client ❑ ❑ 38. Impoundment ❑ 39. Hearing scheduled MACHINE SAFETY AND SANITATION [ [ ❑ 20. Safe machine design ❑ ❑ 40. Closure ❑ 21. Machines cleaned and disinfected between clients ❑ ❑ 41. Received b (Print): Tony Henson Received b Si natur : r/ Phone: 7ffT Specialist (Print): Navjot Sahota Specialist (Signature): Phone: (209) 468-3178 Reinspecion on/about: A reinspection fee of $152 per hour may be charged. Page 1 of EH -11/17 (Y1'__