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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
8/13/2025 3:24:30 PM
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\cfield
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 N*#V - version No.: 0/B <br />IIUM 9sn:RILIVKnON Certification of EO Sterilization ±tC 81V1 Effective date: 2021-04-05 <br />Sterility Testing of BIS Record <br />9P 1�0 <br />Customer <br />Yiwu Limem tattoo equipment co., Ltd <br />T <br />Sterilization date <br />2022-08-28 <br />Sterilization batch <br />2022082805A <br />PCD ' <br />EPCD; ❑ IPCD <br />BI $ij iAJA <br />r0111 I bi A 4 f 01KPR <br />PCD Type <br />Manufacturer <br />Hangzhou Fujie Disinfection Products Co., Ltd <br />M11P <br />1 iF ATCC9372 <br />BI *; <br />Strain <br />Bacillus atrophaeus <br />Lot no. <br />20220615 <br />eANJI H <br />9EMAM <br />WN10ca (PCs) <br />Test Item <br />Sterility testing <br />Test Qty. <br />20 <br />fAINi» <br />*9i10M <br />AV&W-A <br />Test basis <br />ISO 11138-2:2017 <br />Test method <br />Direct immersion <br />A. <br />(TSB) <br />atch <br />201214 <br />Culture medium <br />Cu <br />Medium b <br />:140rF a1 <br />A.rrifffol <br />Incubation temp. <br />35'C <br />I Incubation period <br />7days <br />aA1'fZ5 <br />Electric Constant -temp Incubation Container; <br />Apparatus <br />I21'� A Ultra -Clean Bench; <br />fA9i119 M <br />Test date <br />2022-08-29-2022-09-05 <br />IJ aT lJtarFP%-3�iE3R* BI incubation and examination record <br />BI# <br />1 2 3 4 5 6 7 <br />8 <br />9 10 11 12 13 14 15 16 17 18 19 20 <br />24h— <br />— — — — — — <br />— <br />— — — — — — — — — — — — <br />48h— <br />— — — — — — <br />— <br />— — — — — — — — — — — — <br />72h— <br />— — — — — — <br />— <br />— — — — — — — — — — — — <br />96h— <br />— — — — — — <br />— <br />— — — — — — — — — — — — <br />120h <br />— — — — — — — <br />— <br />— — — — — — — — — — — — <br />144h <br />— — — — — — — <br />— <br />— — — — — — — — — — — — <br />168h— <br />— — — — — — <br />— <br />— — — — — — — — — — — — <br />BI# <br />Positive control Negative control <br />% Note: <br />24h + — <br />48h + — <br />72h + — <br />is meaning <br />no growth"; "+" is meaning "growth". <br />96h + — <br />120h + — <br />144h + — <br />168h + — <br />�� <br />There are no growth with testing items and negative control, while positive control is growth well after specific Incubation <br />Result <br />period. <br />k_A ip, <br />❑X a Conformity; ❑ T A non -conformity. : - - <br />Conclusion <br />j # v <br />499 Inspector: il /1ift QM <br />Reviewer: Fj M Date: <br />AA`.�r1Li%l <br />)4' <br />14- <br />PuL q, <br />*ffiBA QUALITY RECORD 2/2 <br />
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