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i San Joaquin County 1868 East Hazelton Avenue A 95205 Tel: (209)4 4668--34203420 Environmental Health Department Stockton, ��,:'•, Fax: (209)464-0138 BODY ART FACILITY AND PRACTIONER REGISTRATION/ MECHANICAL STUD AND CLASP EAR PIERCING NOTIFICATION I. PROCEDURES TO BE PERFORMED (9 119300) Body Art Practitioner applicant should identify each service that will provided. Body Art Facility owner applicant should identify all the services that will be provided within the facility. TATTOOING- means the insertion of pigment in human skin by piercing with a needle. BODY PIERCING— means the creation of an opening in a human body for the purpose of inserting jewelry or other decoration. "Body piercing" includes, but is not limited to, the piercing of an ear, including the tragus, lip, tongue, nose, or eyebrow. "Body piercing", does not include the piercing of an ear, except for the tragus, with a disposable, single-use, presterilized clasp and stud or solid needle that is applied using a mechanical device to force the needle or stud through the ear. PERMANENT COSMETICS— means the application of pigments in human skin tissue for the purpose of permanently changing the color or appearance of the skin. This includes, but is not limited to, permanent eyeliner, eyebrow, or lip color. BRANDING- means the process in which a mark or marks are burned into human skin tissue with a hot iron or other instrument, with the intention of leaving a permanent scar. MECHANICAL STUD AND CLASP EAR PIERCING (§ 119325)- means the utility of a single use mechanical stud and clasp device for piercing the ear. II. REOUIRED REGISTRATION, PERMIT, OR NOTIFICATION FEES (& 119306, !5 119312, 6 1193251 Applications for registration, facility permit, or notification must include payment of appropriate fees. Please check the appropriate boxes and remit the required fees with your application. ANNUAL BODY ART PRACTITIONER REGISTRATION — Required for all individuals providing body art services. ANNUAL BODY ART FACILITY PERMIT — Required for businesses where tattoo, body piercing, branding, and/or permanent cosmetic services are performed. MECHANICAL STUD AND CLASP EAR PIERCING NOTIFICATION — Required for facilities where mechanical stud and clasp devices are used for piercing the ear. III. APPLICANT INFORMATION (§ 119306, 5 119312, 9 119325) All applicants must provide full name, mailing address, and contact information. All body art practitioners must submit documentation on: Hepatitis B vaccination status, proof of bloodborne pathogen training, and evidence of six-month of related experience. Registrants must also identify the facility where they plan to provide body art services. IV. FACILITY LOCATION (§ 119306, § 119312, § 119325) All applicants must provide the business name, location address, and contact information in which body art and/or mechanical stud and clasp ear piercing procedures are to be performed. If a business has multiple locations, each site must be identified and permitted. One application form may be used to register multiple facility sites for a single business owner. ADMINISTRATIVE POLICY: Your Policy PERMIT FEES: RETURN APPLICATION TO: Your Permit Fee Schedule Name of Your Jurisdiction Your Web Address Rev 12/11 2 of 2