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Environmental Health - Public
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EHD Program Facility Records by Street Name
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4100 – Safe Body Art
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PR0548004
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COMPLIANCE INFO
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Entry Properties
Last modified
4/27/2026 11:14:46 AM
Creation date
3/5/2024 9:14:00 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4100 – Safe Body Art
File Section
COMPLIANCE INFO
RECORD_ID
PR0548004
PE
4121 - BODY ART FACILITY-STERILIZATION
FACILITY_ID
FA0027381
FACILITY_NAME
LOST DREAMS TATTOOS & PIERCING (CARTER, MICHAEL)
STREET_NUMBER
5920
STREET_NAME
PACIFIC
STREET_TYPE
AVE
City
STOCKTON
Zip
95207
CURRENT_STATUS
Active, billable
QC Status
Approved
Scanner
SJGOV\sballwahn
Supplemental fields
Site Address
5920 PACIFIC AVE STOCKTON 95207
Tags
EHD - Public
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_V'4W'4 Doc.No. HYST/QR2-25-06 <br /> "i U i` 7D0 jf Version No.: 0/B <br /> ❑UMM SIT.RILIVKnON Certification of EO Sterilization ±tC EINJ Effective date: 2021-04-05 <br /> t"MiTVA)EM 9ti� <br /> Sterility Testing of IBIS Record <br /> Yiwu Limem tattoo equipment co.,Ltd <br /> Customer <br /> Sterilization date 2022-08-28 STterMilizationbatch 2022082805A <br /> PCD AtO EPCD; ❑IPCD BI$ij iAJA rJ1111 I bi A 4 f porA PR <br /> PCD Type Manufacturer Hangzhou Fujie Disinfection Products Co.,Ltd <br /> M11P 1 iF ATCC9372 BI*4� 20220615 <br /> Strain Bacillus atrophaeus Lot no. <br /> eANJI H 9EMAM WN10ca (PCs) 20 <br /> Test Item Sterility testing Test Qty. <br /> fAI NIHM ISO 11138-2:2017 *9i1)J-9 AV&W-A <br /> Test basis Test method Direct immersion <br /> A. <br /> b Culture medium (TSB) Medium atch 201214 <br /> Cu <br /> :140rF a 1 35'C A.rriftf7 7days <br /> Incubation temp. I Incubation period <br /> a91'fZ5 Electric Constant-temp Incubation Container; <br /> Apparatus I21'�A Ultra-Clean Bench; <br /> fA9i119 M 2022-08-29—2022-09-05 <br /> Test date <br /> 9J#aT IJ rFP%-3�iE3R*BI incubation and examination record <br /> BI# 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 <br /> 24h — — — — — — — — — — — — — — — — — — — — <br /> 48h — — — — — — — — — — — — — — — — — — — — <br /> 72h — — — — — — — — — — — — — — — — — — — — <br /> 96h — — — — — — — — — — — — — — — — — — — — <br /> 120h — — — — — — — — — — — — — — — — — — — — <br /> 144h — — — — — — — — — — — — — — — — — — — — <br /> 168h — — — — — — — — — — — — — — — — — — — — <br /> BI# Positive control Negative control <br /> 24h + — <br /> 48h + — <br /> 72h + — Note: <br /> is meaning <br /> 96h + — no growth";"+"is meaning"growth". <br /> 120h + — <br /> 144h + — <br /> 168h + — <br /> A#9fL�AI� ft tRRa#IM,5i <br /> ul There are no growth with testing items and negative control,while positive control is growth well after specific Incubation <br /> Result period. <br /> kAip, ❑X a4 Conformity; ❑T A non-conformity. - <br /> Conclusion j ;.y v <br /> r� <br /> �yInspector: Q�D e: <br /> :r'--' 777_7/ 9 <br /> Si 1r'S� <br /> 1 <br /> Reviewer: Fj M Date: )nl4j <br /> f -ffiBA QUALITY RECORD 2/2 <br />
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