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4100 – Safe Body Art
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PR0541082
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COMPLIANCE INFO
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Entry Properties
Last modified
3/30/2023 12:24:01 PM
Creation date
7/3/2020 10:13:05 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4100 – Safe Body Art
File Section
COMPLIANCE INFO
RECORD_ID
PR0541082
PE
4120
FACILITY_ID
FA0023520
FACILITY_NAME
SHANMARIE (MEDER, SHANNON)
STREET_NUMBER
233
STREET_NAME
DORRIS
STREET_TYPE
PL
City
STOCKTON
Zip
95204
CURRENT_STATUS
02
SITE_LOCATION
233 DORRIS PL
P_LOCATION
01
QC Status
Approved
Scanner
SJGOV\cfield
Supplemental fields
FilePath
\MIGRATIONS\BA\BA_4110_PR0541081_233 DORRIS_.tif
Tags
EHD - Public
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28 <br /> The Releasor,having read and been verbally told of all of the above Recitals by the Releasee,nevertheless,desires to have the permanent cosmetic <br /> facial tattoo procedure(s)performed by that Releasee and is willing to enter into this agreement.The Releaser has been given an opportunity to <br /> ask questions about the procedures and the implements to be used and the risks and hazards involved and believes that he/she has sufficient <br /> information to give this informed consent. <br /> I have read,been verbally told,and understand each of the above recitals <br /> (customer signature) (date) <br /> Photographer's model release <br /> I the Releasor consent to have my picture taken by the Releasee for Before and After photos,record-keeping purposes,and any portfolio related <br /> work/work-ups as the Releasee sees fit. <br /> (customer signature) (date) <br /> AMML <br /> This document is Copyright protected by SofrapO Inc. It may not be reproduced without the expressed written permission of Soffap(&Inc. <br /> Call 925 248-6301 or write to 550 N. Canyons Parkway, Livermore,CA 94551. All rights reserved. 0 Copyright,2014 SofFapOD Inc. Seek legal advice <br /> before using this document. <br />
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