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Body Art Inspection Report Date: June 11 , 2021 <br /> N San Joaquin County Environmental Health Department Program <br /> 1868 E. Hazelton Ave., Stockton, CA 95205 Record: PR0546977 <br /> 14) (209) 468-3420 <br /> Program <br /> vrxwsioov.oralehd <br /> Element: 4120 <br /> Facility Name Address City Zip Code <br /> Pure Form Gallery & Tattoo 213 W Yosemite Ave Manteca 95337 <br /> Name of Permit/Registration Holder Permit Exp. Date Time In Time Out Inspection Type <br /> William Edgington 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 /> Parts replaced between clients - grommets, elastic bands, <br /> El 1 . Autoclave: approved and effective - passed integrator test ❑ El 22. etc. ❑ <br /> Items washed, disinfected, packaged, labeled , and <br /> El 2. sterilized ❑ 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 ❑ 24. Appropriate chemical disinfectant used <br /> Decontamination/sanitation area separated and supplied El Chemical used: El <br /> El 5' a ro riatel El <br /> ❑ 6 Invoices and log kept for disposable, pre-sterilized El El <br /> Disinfectant used. appropriately/sufficient contact time <br /> equipment El ❑ <br /> ❑ 7 Sharps containers labeled, used, and disposed of El contact time provided: <br /> a ro riatel <br /> Jewelry, tattoo and piercing equipment - clean and <br /> ❑ 8' sterilized ElEl26. Barriers used El <br /> PRACTITIONER HEALTH AND HYGIENE ❑ 27. Products applied to skin are single use/dispensed aseptically ❑ <br /> ❑ 9. No eating, drinking or smoking - clean clothes ❑ ❑ 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 /> Handwashing facilities properly supplied and accessible, <br /> ❑ 11 . [I El 30. Cross-contamination avoided during all phases of procedure <br /> warm water <br /> ❑ 12. Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES <br /> 13. Bloodborne Pathogen training ❑El 31 Areas separated/no living or sleeping quarters ❑ <br /> ❑ Source: ❑ 32. Floors and walls clean and in good repair, adequate light El <br /> l14 Appropriate personal protective equipment available and El El 33 Workstation, surfaces, including chairs, armrests, etc. in Elusedgood repair <br /> CUSTOMERSICLIENTS ❑ 34. Permit/registmtion posted. ❑ <br /> Branding is completed with no other customers in <br /> El El 35. Operation and employee training records present <br /> El 15. procedure area <br /> ❑ <br /> ❑ 16. Customers eighteen (18) years of age or older ❑ COMPLIANCE AND ENFORCEMENT <br /> ❑ 17. Skin adequately prepared for procedurejandEl <br /> ❑ 36. Plan(s) submitted for review ❑ <br /> Client records approved and available - Consent fo ❑❑ 18. uestionnaire ❑ 37. Permits obtained and available❑ 19. Appropriate aftercare instructions given to client ❑ 38. ImpoundmentMACHINE SAFETY AND SANITATION ❑ 39. Hearing scheduled❑ 20. Safe machine design ❑ 40. Closure ❑ <br /> ❑ 21 . Machines cleaned and disinfected between clients ❑ ❑ 41 . ❑ <br /> Received by (Print): William Edgington Received by (Signature): EMAILED Phone: 209-204-9925 <br /> Specialist (Print): Sandip Singh Specialist (Signature): Phone: 209-468-3526 <br /> Reinspection on/about: A reinspection fee of $152 per hour may be charged. Page 1 of 2 <br /> EH-11 /17 <br />