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Body Art Inspection Report Date(MM/DD/YY) 13--17-13 oy County of San Joaquin County,Environmental Health Department 1868 E.Hazelton Ave.,Stockton CA 95205 Permit Number _S60676WO (209)468-3420 www.slgov.oro/ehd Permit Type '1 FO Facility Name Address City Zip Code CT Q n,n I vteV l�vnF f z S, tkn Slt M CA� 6 �i Q� G, � tcx C l-nn Gsd G`7 Pen-nit/Registration Holder Name Permit Exp.Date Total Time Inspection Type RISK FACTORS AND INTERVENTIONS Risk factors are improper practices or procedures identified as contributing factors of cross-contamination. Interventions are control measures to prevent cross-contamination and transfer of pathogens from one person to another. In=In Compliance Out=Not in Compliance N/O=Not Observed N/A=Not Applicable COS=Corrected On Site TATTOO AND PERMANENT COSMETICS MACHINE RUN,CLEANING AND STERILIZATIO ,, SAFETY AND SANITATION our cos In 1. Autoclave is approved and effective-passed 0 0 n N/O 18. Safe machine design 0 0 /A integrator test NIA In 10 2. Process of cleaning,labeling,packaging and 0 0 n NIO 19. Machines cleaned and disinfected between 0 0 stediziin items correct) N/A clients In-J91-0 3. Autoclave loaded correctly/packages allowed to 0 0 N/O 20. Parts replaced between clients-grommets, 0 0 / d NIA elastic bands,etc. In /0 4. Integrators used/monthly spore testllog *�r QRE11E IN Rt}SS=GO[d1AININATION A 11 maintained :( `' In 0 5. Decontamination/sanitation area separate and 0 0 n N/0 21. Workstation/procedure area decontaminated A supplied* NIA In N/0 6. Invoices and log kept for disposable,pre- 0 n N/O 22. Chemical disinfectant used 0 0 Ej N/A sterilized equipment,backupsupplies available* N/A Chemical used: (&Oc;be, w`)p n N/0 7. Sharps containers supplied,labeled,used and n N/O 23. Disinfectant used sufficient contact time Wet /A disposed of correct( * N/A contact time rovided:& In N10 8. Jewelry,tattoo and piercing equipment-storage &N/0 24. Barriers available and used as part of NIA and use N/A procedure NIO 25. Products applied to skin are single . 11 13 PRACTI7INEI1 ESA Y N H 1 #, -: A use/dispensed aseptically Un WO 9. No eating,drinking or smoking-dean clothes n N/O 26. Storage of inks,pigments,needles,tubes,etc., 0 N/A 0 El N/A I NIO 10. Hands washed effectively and timely 0 0 N/0 27. Jewelry,Inks,Needles etc approved and used NIA I N/A In N/0 11. Handwashing facilities properly supplied and N/0 28. Cross-contamination avoided during all phases N/A accessible,warm potable water NIA of procedure n N/0 12. Personal protective equipment available and s s BEST BUSINESS PI#J"CTICES�; _-R N/A used,eyewash station available k. CUSTOMERSICLIEN N In 29. Areas separated/no living or sleeping 0 11 f. ii / quarters/no animals 1 In 0 13. Branding is completed with no other customers in 0 13 N/0 30. Floors and walls dean and in good repair, 0 0 procedure area N/A adequate light* N/0 14. Customers eighteen(18)years of age or older N/0 31. Workstation,surfaces,including chairs,,etc.in 0 0 _N/A N/A good repair;trash removed frequently* Un N/O 15. Skin prepared for procedure. 0 0 NIO 32. Permit/registration and required signs posted* 0 0 NIA N/A In N/O 16. Client records available-Consent form& 0 In N/O 33. IPCP and employee training records and 0 NIA questionnaire NIA He atitiis B vaccination status present In WO 17. Aftercare instructions given to client 0 In N10 34 Restrooms available,stocked NIA I NIA 0 see- Lct_��- Received by(Print): Received by(Signature): Phone: Specialist(Print): Specialist(Signature): Phone: ❑ This report is an Official Notice of Violation.Corrections must be completed in the time specified. A reinspection fee may be charged if violations noted on this report are not corrected by the reinspection date. Reinspection Date(on or about) Page I of_ l