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o Body Art Inspection Report Date: July 10,2024 (y San Joaquin County Environmental Health Department Program (( i 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: PR0548004 (209)468-3420 Program w ww.sioay.orq/ehd Element: 4121 tJi Facility Name Address City Zip Code Lost Dreams Tattoo and -3iercing 5920 Pacific Ave Stockton 95207 Name of Permit/Registration Holder Permit Exp. Date Time In Time Out Inspection Type Michael Carter 6/30/2025 Routine The facility is inspected for compliance with Division 104,Part 15,Cha ter 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,1' integrator tes- El ❑ 22 elastic bands,etc. ❑ HSC 119309-Items washed,disinfected,packaged, El 2' labeled,and sterilized El CROSS-CONTAMINATION HSC 119315-Autoclave loaded correctly/packages ❑ 3. allowed to d ❑ ❑ 23. HSC 119309 Workstation/procedure area decontaminated El ® HSC 119315-Integrators used/monthly spore test/log 4. maintained ❑ 24. HSC 119301 -Appropriate chemical disinfectant used El ❑ HSC 119314-Decontamination/sanitation area separated El 5' and supplied a ro riatel El Chemical used: ❑ 6 HSC 119315-Invoices and log kept for disposable,pre- ❑ 25 HSC 119309-Disinfectant used appropriately/sufficient sterilized a ui ment ® contact time ❑ HSC 119314-Sharps containers labeled,used,and El 7' ❑ Wet contact time provided: 3 mins disposed of appropriately ❑ 8 HSC 119310, 119315-Jewelry,tattoo and piercing ❑ ❑ 26. HSC 119314-Barriers used ❑ equipment-clean and sterilized HSC 119311 -Products applied to skin are single PRACTITIONER HEALTH AND HYGIENE El 27 use/dispensed aseptically ❑ ❑ 9 HSC 119309-No eating,drinking or smoking-clean ® ❑ 28 HSC 119309, 119311 -Storage of inks,pigments,needles, ❑ clothes tubes,etc. HSC 119310, 119311 -Jewelry, Inks,Needles etc approved ❑ 10. HSC 119308-Hands washed effectively and timely ❑ ❑ 29. 9 and used correctlyEl ❑ HSC 119314-Handwashing facilities properly supplied HSC 119308-Cross-contamination avoided during all 11. and Eccessible,warm water El ❑ 30 phases of procedure El ❑ 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 El El Source: 32. HSC 119314-Floors and walls clean and in good repair, ® ❑ adequate light HSC 119308-Appropriate personal protective equipment HSC 119314-Workstation,surfaces,including chairs, El14. available and used El ® 33' armrests,etc.in good repair ❑ CUSTOMERS/CLIENTS ® 34. HSC 119312-Permit/registration posted ❑ HSC 119309-Branding is completed with no other HSC 119313-Operation and employee training records El 15. custcmers in procedure area El ® 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. Eluestionnaire ® 37. HSC 119312-Permits obtained and available Consent form and ❑ HSC 119303, 119308-Appropriate aftercare instructions ® 19' iver to client El El HSC HSC 119319 Impoundment El 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 ❑ r[--] 41 ❑ clien z Received by(Print): Michael Carter Received by(Signature): EMAILED Phone:209-696-5757 Specialist(Print). Sand p Singh Specialist(Signature): anc�i�o- Phone:209-468-3526 Reinspection of/about A reinspection fee of$172 per hour may be charged. Page 1 of 4 EH-11/17