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�pUlry o Body Art Inspection Report Date: 4/2/2026 San Joaquin County Environmental Health Department Program 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: PR0548004 (209)468-3420 Program www.siogy.orq/ehd gti.F oRa� Element: 4121 Facility Name Address City Zip Code Lost Dreams Tattoo and Piercing 5920 Pacific Ave. Stockton 95207 Name of Permit/Registration Holder Permit Exp.Date Time In Time Out Inspection Type Michael Carter June 30,2026 Routine The 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 HSC 119315-Autoclave:approved and effective-passed HSC 119311 -Parts replaced between clients-grommets, El 1 integrator test ❑ ❑ 22 elastic bands,etc. El ❑ HSC 119309-Items washed,disinfected, packaged,2. labeled,and sterilized El CROSS-CONTAMINATION ❑ HSC 119315-Autoclave loaded correctly/packages 3' allowed to d ❑ El23. HSC 119309 Workstation/procedure area decontaminated El ® HSC 119315-Integrators used/monthly spore test/log 4. El24. HSC 119301 -Appropriate chemical disinfectant used maintained ❑ ❑ HSC 119314-Decontamination/sanitation area separated El 5. and supplied appropriately El Chemical used: ® 6 HSC 119315-Invoices and log kept for disposable,pre- ❑ 25 HSC 119309-Disinfectant used appropriately/sufficient sterilized equipment ❑ contact time ❑ ® HSC 119314-Sharps containers labeled, used,and 7 ro riatel El Wet contact time provided: disposed of a HSC 119310, 119315-Jewelry,tattoo and piercing El 8. equipment-clean and sterilized El El26. HSC 119314-Barriers used ❑ HSC 119311 -Products applied to skin are single PRACTITIONER HEALTH AND HYGIENE El 27� use/dispensed asepticallyEl ❑ 9 HSC 119309-No eating,drinking or smoking-clean ❑ ❑ 28 HSC 119309, 119311 -Storage of inks,pigments, needles, ❑ clothes tubes,etc. ❑ 10. HSC 119308-Hands washed effectively and timely ❑ ® 29 HSC 119310, 119311 -Jewelry,Inks, Needles etc approved ❑ and used correct) HSC 119314-Handwashing facilities properly supplied and HSC 119308-Cross-contam El ination avoided during all El 11. accessible,warm water El ❑ 30. phases of procedure ❑ 12. HSC 119306-Hepatitis B vaccination ❑ BEST BUSINESS PRACTICES 13. HSC 119307-Bloodborne Pathogen training ❑ 31. HSC 119314-Areas separated/no living or sleeping quarters ❑ ® ❑ HSC 119314-Floors and walls clean and in good repair, Source: ❑ 32. adequate light HSC 119308-Appropriate personal protective equipment HSC 119314-Workstation,surfaces,including chairs, ❑ 14. available and used ❑ ® 33. armrests,etc.in good repair ❑ CUSTOMERS/CLIENTS ❑ 34. HSC 119312-Permit/registration posted ❑ ❑ 15. HSC 119309-Branding is completed with no other HSC 119313-Operation and employee training records ❑ customers in procedure area ❑ ❑ 35, resent ❑ 16. HSC 119302-Customers eighteen(18)years of age or ❑ older COMPLIANCE AND ENFORCEMENT ❑ 17. HSC 119308-Skin adequately prepared for procedure ❑ ❑ 36. HSC 119312-Plan(s)submitted for review ❑ ® HSC 119303-Client records approved and available 18. questionnaire ❑ El37. HSC 119312-Permits obtained and available Consent form and ❑ ❑ 19 HSC 119303, 119308-Appropriate aftercare instructions iven to client ❑ ❑ 38. HSC 119319 Impoundment ❑ MACHINE SAFETY AND SANITATION ❑ 39. HSC 119320-Hearing scheduled ❑ ❑ 20. HSC 119311 -Safe machine design ❑ ❑ 40. HSC 119312, 119317, 119320-Closure ❑ ❑ 21 HSC 119311 -Machines cleaned and disinfected between ❑ ❑ 41. ❑ clients Received by(Print): Micheal Carter Received by(Signature): EMAILED Phone:209-696-5757 Specialist(Print): Stephanie Ramirez Specialist(Signature): cSLGrt�� Phone:209-616-3069 Reinspection on/about: A reinspection fee of$179 per hour may be charged. Page 1 of 3 EH-11/17