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Body Art Inspection Report San Joaquin County Environmental Health Department 1868 E. Hazelton Ave., Stockton, CA 95205 (209)468-3420 www s'oav ora/ehd Facility Name Name of PermitlRegistration Holder Address 9210 Thornton Rd. Permit Exp. Date Time In Dale: November 1, 2021 Program Record: New PR# Program Element: 4120 City Zip Code Stockton 95208 Time Out Inspection Type Antoinette Ernest 6/30/22 Routine The above facility is inspected for compliance with Division 104, Part 15, Chapter 7 of California Health and Safety Code (HSC). V = VInlalinn r. = rnrrected nn Sita Received by (Print) Antoinette Ernest Received by V MACHINE SAFETY AND SANITATION cont: C V CLEANING AND STERILIZATION C El Parts replaced between clients - grommets, elastic bands, 22. etc. El ❑ 1. Autoclave: approved and effective - passed integrator test ❑ PREVENTING CROSS -CONTAMINATION ❑ 2' Items washed, disinfected, packaged, labeled, and sterilized ❑ ❑ 23. Workstation/procedure area decontaminated ❑ ❑ 3. Autoclave loaded correctly/packages allowed to dry ❑ El 24. Appropriate chemical disinfectant used El ❑ 4. Integrators used/monthly spore testilog maintained ❑ used: 5. Decontamination/sanitation area separated and supplied appropriately ❑ ❑ 25. Disinfectant used approprlatelylsuffcient contact time ❑ ❑ 6 Invoices and log kept for disposable, pre -sterilized equipment ❑ Wet contact time provided: ❑ 7 Sharps containers labeled, used, and disposed of appropriately ❑ El 26. Barriers used Elsterilized El 8 Jewelry, tattoo and piercing equipment - clean and El ❑ 27. Products applied to skin are single use/dispensed aseptically ❑ PRACTITIONER HEALTH AND HYGIENE ❑ 28. Storage of inks, pigments, needles, tubes, etc. ❑ ❑ 9. No eating, drinking or smoking - clean clothes ❑ ❑ 29. Jewelry, Inks, Needles etc approved and used correctly ❑ ❑ 10. Hands washed effectively and timely ❑ 30. Cross -contamination avoided during all phases of procedure ® 11 Handwashing facilities properly supplied and accessible, warm water ElEl❑ BEST BUSINESS PRACTICES ❑ 12. Hepatitis B vaccination ❑ ❑ 31. Areas separated/no living or sleeping quarters ❑ ❑ 13. Bloodborne Pathogen training ❑ 9 32. Floors and walls clean and in good repair, adequate light ❑ Source: ❑ 33 Workstation, surfaces, including chairs, armrests, etc. in repair ❑ El 14 Appropriate personal protective equipment available and usedgood El ❑ 34. Permil/registration posted ❑ CUSTOMERS/CLIENTS ❑ 35. Operation and employee training records present ❑ ❑ 15. Branding is completed with no other customers in procedure area ❑ COMPLIANCE AND ENFORCEMENT ❑ 16. customers eighteen (18) years of age or older ❑ ❑ 36. Plan(s) submitted for review ❑ ❑ 17. Skin adequately prepared for procedure 37. Permits obtained and availableuestionnaire ❑ 18 Client records approved and available -Consent for ❑ 38. Impoundment ❑MACHINE ❑ 19. Appropriate aftercare instructions given to client JE] ❑ 39. Hearing scheduled ❑❑ SAFETY AND SANITATION ❑ 40. Closure❑ 20. Safe machine design ❑ 41. ❑ 21. Machines cleaned and disinfected between clients Relnspectlon A reinspection fee of $152 per hour may be charged. Page 1 of 2 EH -11117 Received by (Signature) Emailed Phone: 209-507-9208 Specialist (Print) Sandip Singh Specialist (Signature)' J �-n- �c Phone: 209-468-3526 Relnspectlon A reinspection fee of $152 per hour may be charged. Page 1 of 2 EH -11117