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Medical Waste Hauler <br /> Street Address 4s Y <br /> City, ST, Zip <br /> I. Sterilization of Jewelry: Describe the procedure for the sterilization of jewelry prior to placing into <br /> newly pierced skin. (HSC 119310 (a) and 119315) <br /> J. Sterilization Equipment: List the equipment used in the decontamination and sterilization room <br /> and describe the procedure for decontaminating instruments prior to placing inside the autoclave. <br /> Indicate whether instruments are manually washed or machine washed, such as with an <br /> Ultrasonic machine. Include the material used for soaking dirty instruments in the machine, <br /> such as Tergazyme. (HSC 119309 (b)(e)(g), 119314 (c), and 119315;L.,- <br /> We r•lv 1101 - VJP cCY7 Glu 4&1-luy-t ea A Jrkri- <br /> stc Qrhac vsp r�lr�sib1d- ea_OfV*t-eh A . <br /> K. Disinfection Products: List the disinfectant products used at the body art facility. (HSC 119301 <br /> (k) and 119308 (b)(6)) <br /> �xiar do AA aINM <br /> L. Time and Temperature: List the duration of time and temperature of the autoclave required for <br /> the sterilization of clean instruments. Indicate whether a sterilization log is maintained on-site. <br /> Indicate whether each sterilization load is tested using Class 5 integrators. (HSC 119315 <br /> (b)(3)(5)) <br /> Time <br /> Temperature <br /> Psi I <br /> M J= y S P C II �O - e:lOU t , CALd(SCaD_3ibW . <br /> M. Personal Protective Equipment: List the personal protective equipment used during a body art <br /> procedure. (HSC 119308 (a) and 119309 (j)) <br /> �IOUREN MR --a- lb T f 0 C i�IA Vlallfr- 'NA-eir,60 COURCSd <br /> A rl 6 At ens;b le <br /> Page 5 of 10 <br />