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t � PQ U 1___ Body Art Inspection ction Re port San Joaquin County Environmental Health Department Date: 7/26/2023 1868 E. Hazelton Ave., Stockton, CA 95205 Program ' (209) 468-342D Record: SR0087001 www.siogv.org/ehd trFORa Program Element: 4103 Facility Name Address City Zip Code Adorn Beauty Ink 5759 Pacific Ave 8145 Stockton 95207 Name of Permit/Registration Holder Permit Exp. Date Time In Time Out Inspection Type Jennifer Bou Consultation 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 I CLEANING AND STERILIZATION C V MACHINE SAFETY AND SANITATION (cont.) _-F C ❑ 1. Autoclave: approved and effective -passed integrator test ❑ ❑ 22 Parts replaced between clients -grommets, elastic bands, ❑ etc. ❑ 2 Items washed, disinfected, packaged, labeled, and Elsterilized PREVENTING 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 El appropriately used: ® 6 Invoices and log kept for disposable, pre -sterilized ❑ 25. Disinfectant equipment used appropriately/sufficient contact time El 7 Sharps containers labeled, used, and disposed of ❑ El Wet ❑ appropriately contact time provided: ❑ 8 Jewelry, tattoo and piercing equipment - clean and ❑ ❑ 26. Barriers sterilized used ❑ PRACTITIONER HEALTH AND HYGIENE ❑ 27. Products applied to skin are single use/dispensed 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 warm water -contamination avoided during all phases of procedure ❑ ❑ 12. Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES El 13. Bloodborne Pathogen training ❑ 31. Areas separated/no living or sleeping quarters ❑ ❑ Source: ❑ 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 good repair Elused CUSTOMERS/CLIENTS ❑ 34. Permit/registration posted ❑ ❑ 15. Branding is completed with no other customers in ❑ ❑ 35. Operation procedure area and employee training records present ❑ ❑ 16. Customers eighteen (18) years of age or older ❑ COMPLIANCE AND ENFORCEMENT ❑ 17. Skin adequately prepared for procedure ❑ ❑ 36. Plan(s) submitted for review ❑ ® 18 Client records approved and available - Consent form and ❑ ❑ 37. questionnaire Permits obtained and available ❑ ❑ 19. Appropriate aftercare instructions given to client ❑ ❑ 38. Impoundment ❑ MACHINE SAFETY AND SANITATION ❑ 39. Hearing scheduled ❑ ❑ 20. Safe machine design ❑ ❑ 40. Closure ❑ ❑ 21. Machines cleaned and disinfected between clients ❑ ❑ 41. ❑ Received by (Print): Received by (Si nature) EMAILED Phone: 209326 3940 Specialist (Print): Stephanie Ramirez Sr. REHS Specialist (Signature): Phone: 209 616 3069 Reinspection on/about: A reinspection fee of $162 per hour may be charged. Page 1 of 3 EH -11/17