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Environmental Health - Public
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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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\ I ® � �- {{3 p )Zj'f�-ti Doc.No. HYST/QR2-25-06 <br /> h f� 7V� jk.%y-Version No.: 0/B <br /> 11UAN19 SnMIU MtON Certification of EO Sterilization > B JUi Effective date: 2021-04-05 <br /> Sterility Testing of Bls Record <br /> Yiwu Limem tattoo equipment co.,Ltd <br /> Customer <br /> Sterilization M ati date 2022-08-23 Sterilization batch 2022082305A <br /> PCD AN EPCD; El IPCD BI 9 1 �n�'I'��# 'l �rip (I�%`p7 <br /> PCD Type Manufacturer Hangzhou Fujie Disinfection Products Co.,Ltd <br /> VIP 'MVJf4 M ATCC9372 BI M-i� 20220615 <br /> Strain Bacillus atrophaeus Lot no. <br /> *VJMN �cMtl VV,1 aif0Via (PCs) 20 <br /> Test Item Sterility testing Test Qty. <br /> 4i�LlMf1 A ISO11138-2:2017 * 9;19 { <br /> Test basis Test method Direct immersion <br /> Culture u�e medium MMtR��94fA�LA (TSB) Medium batch201214 <br /> AnaA 35`C f"_)14F�Io Ida s <br /> Incubation temp. Incubation period y <br /> ftMfka MiA,rr$9 Electric Constant-temp incubation Container; <br /> Apparatus jr_V =VHF A Ultra-Clean Bench; <br /> 4M R M 2022-08-24-2022-08-31 <br /> Test date <br /> A#aT lJfn FPL#iE3RA 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 — — I — — — — — — — — — — — — — — — — — — <br /> 144h — — — — — — — — — — — — — — — — — — — — <br /> 168h — — I — — — — — — — — — — — — — — — — — — <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� QMItX11 M ATS pflft to �tl�� k; Ja #a AM ttf7� <br /> V9 �co <br /> Result There are no growth with testing items and negative control,while positive control is growth well after specific Incubation <br /> period. <br /> DX A Conformity; ElT A 4 non-conformity. !, <br /> Conclusion <br /> At <br /> Inspector: <br /> 1 L ;'_4— <br /> Y_4,0<�Reviewer: / Q Date: <br /> �i� QUALITY RECORD 2/2 <br />
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