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(1, coBod Art Ins ection Re ort0v p p Date: May 13, 2022 sSan Joaquin County Environmental Health Department Program 1868 E. Hazellon Ave., Stockton, CA 95205 Record: SR0085220 (209)468-34204 •w .sioay.om/ehdProgram epp RA Element: 4103 Facility Name Address City Zip Code Cactus Flower Tattoo Studio 1012 W Lodi Ave Lodi 95240 Name of Permit/Registration Holder Permit Exp. Date Time In Time Out Inspection Type Paul Marquez Consultation The above facility is inspected for compliance with Division 104, Part V Received by (Print): Paul Marquez Received by (Signature): CLEANING AND STERILIZATION C V 15, Chapter 7 of California Health and Safety Code (HSC) integrator lest V = Violation C = Corrected On Site El V Received by (Print): Paul Marquez Received by (Signature): CLEANING AND STERILIZATION C V MACHINE SAFETY AND SANITATION cont. c E]1. integrator lest El El22. Parts replaced between clients - grommets, elastic bands, El Autoclave: approved and effective - passed etc. E:1 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 ❑ 1:1E] 5' Decontamination/sanitation area separated and supplied ❑ Chemical used: ro riatel appropriately ❑ 6. 6' Invoices and log kept for disposable, pre -sterilized El25. Disinfectant used appropriately/sufficient contact time equipment ® ❑ ❑ 7. Sharps containers labeled, used, and disposed of ❑ Wet contact time provided: 2 minutes appropriately I ❑ 8 Jewelry, tattoo and piercing equipment- clean and ❑ ❑ 26. Barriers used ❑ sterilized ❑ 27. Products applied to skin are single use/dispensed aseptically ❑ PRACTITIONER HEALTH AND HYGIENE ❑ 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 ❑ El 11. Handwashing facilities properly supplied and accessible, ❑ [1F130. Cross -contamination avoided during all phases of procedure warm water ❑ 12. Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES 13. Bloodborne Pathogen trainingaavailable ❑ 31. Areas separated/no living or sleeping quarters ❑ ❑ ❑ Source: ❑ 32. Floors and walls clean and in good repair, adequate light ❑ ❑ Appropriate personal protective equipm ❑ ❑ 33. Workstation, surfaces, including chairs, armrests, etc. in ❑ 14. 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 ❑ rocedure 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 and El 37. Permits obtained. and available ❑ questionnaire ❑ 19. Appropriate aftercare instructions given to client ❑ ❑ 38. Impoundment ❑ ❑ 39. Hearing scheduled ❑ MACHINE SAFETY AND SANITATION E]20. Safe machine design El El 40. Closure ❑ El 21. Machines cleaned and disinfected between clients ❑ El 41. ❑ EMAILED Phone: 209-747-9009 Specialist (Print)' Sandip Singh Specialist (Signature) 5'n �/gip. �zN� Phone: 209-468-3526 Reinspection on/about: A reinspection fee of $152 per hour may be charged. Page 1 of 2 EH -11/17