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COMPLIANCE INFO
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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E
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88 (STATE ROUTE 88)
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13500
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4100 – Safe Body Art
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PR0541030
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COMPLIANCE INFO
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Entry Properties
Last modified
11/20/2024 9:23:24 AM
Creation date
7/3/2020 10:13:43 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4100 – Safe Body Art
File Section
COMPLIANCE INFO
RECORD_ID
PR0541030
PE
4120
FACILITY_ID
FA0023514
FACILITY_NAME
THE RAVEN TATTOO & ART GALLERY (FREDERICKSEN, ROBERT)
STREET_NUMBER
13500
STREET_NAME
STATE ROUTE 88
City
LOCKEFORD
Zip
95237
CURRENT_STATUS
02
SITE_LOCATION
13500 HWY 88
QC Status
Approved
Scanner
SJGOV\cfield
Supplemental fields
FilePath
\MIGRATIONS\BA\BA_4120_PR0541030_13500 HWY 88_.tif
Tags
EHD - Public
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Uy� <br /> WAIVER, RELEAS <br /> 114 <br /> `LEASE READ AND BE CERTAIN, <br /> NS OF SIG . <br /> .i ,. <br /> f-}lS DOCUMENT i5 TW <br /> t3 pAdSkPLEA8E1 "L�.. %S P " °YiDED AFi <br /> 1 . <br /> To SHOW THAI � • <br /> In consideration of receiving a tattoo frorn Robart- en at"The Rouen &Art e "(toget <br /> it's employees,apprentices,, and agents), I agree to the following: ' <br /> _ __{clearly PRINT your name)have be�h;#uldy 1h o._ t risks, <br /> That i � ding, <br /> associated with getting a tattoo I fully understand that these risks,known and r Atex <br /> but not limited to infection,scarring,difficulties detecting melanoma,and allergin ` <br /> gloves,and/or soap,Having been informed of the potential risks associated with om <br /> proceed with the tattoo application and l freely accept and I expressly assume any <br /> tattooing. <br /> .x <br /> ,amu � . , " ; .>•.fl���" . <br /> TO WAIVE AND RELEASE to the fullest extent peirltitted by law each of the Artist ando Studio from all liability <br /> whatsoever,for any and all claims or0a,that 1,rtit estate,�execut�'� Y <br /> have for <br /> entraf � or arl�MM <br /> r personal Injury or otherwise,includino�t t M�:,, <br /> application of my tattoo,whether caused by neg)I Studt+a,`or otherwise. <br /> the <br /> That both the:l3rtist and Tattoo Studio have givenrttetheft it WM ask any and all questions about the <br /> application of`my'tattoo,and all my questions ha��t <br /> rt <br /> �I satisfaction <br /> ter a` frRa <br /> `5 x P 8 } <br /> The Artist and the Tattoo Studio have given me instructions on the care of my tattoo while it is healing,and I tr <br /> understand them and will follow them.i acknowledge that it is possible that the tattoo can be become in ec <br /> =particularly if_I do not follow the Instructions given to me,If any touch-up work to the tattoo is needed due to IpX <br /> my <br /> negligence,I agree that the work will be done at my own expense. - <br /> .60-4'aA,5,6k T <br /> hln� <br /> I am not und�l' <br /> duress or Cobh , <br /> orltAcz 40- <br /> Mark oily ; <br /> E <br /> . � <br /> r �e� sx <br /> to <br /> antibioticst <br /> t� <br /> � - r other bleeding disorders � <br /> disease E <br /> txtents for antibiotics prior to surgery or dental procedures <br /> ;t "ation <br /> ex .xm ors for blood borne pathogen&_ <br /> g� the prescribed antativE <br /> n organ or boCt �,". <br /> .. <br /> adva <br /> that is required: nce ityor <br /> lh U <br /> have amental impairment that M t rttyAm <br /> e <br /> t <br /> .. '� � f r•i5'. f {'�'4+. <br />
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