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COMPLIANCE INFO_CARRIE BLUBAUGH
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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LUCILE
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1955
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4100 – Safe Body Art
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PR0544775
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COMPLIANCE INFO_CARRIE BLUBAUGH
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Entry Properties
Last modified
5/23/2024 9:12:51 AM
Creation date
7/3/2020 10:14:47 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4100 – Safe Body Art
File Section
COMPLIANCE INFO
RECORD_ID
PR0544775
PE
4120
FACILITY_ID
FA0025452
FACILITY_NAME
AESTHETICS LASH INK (BLUBAUGH, CARRIE)
STREET_NUMBER
1955
STREET_NAME
LUCILE
STREET_TYPE
AVE
City
STOCKTON
Zip
95209
CURRENT_STATUS
02
SITE_LOCATION
1955 LUCILE AVE STE B
P_LOCATION
01
QC Status
Approved
Scanner
SJGOV\cfield
Supplemental fields
FilePath
\MIGRATIONS\BA\BA_4120_PR0544775_1955 LUCILE_.tif
Tags
EHD - Public
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Aesthetics Lash Ink — 1955 Lucile Ave #B , Stockton CA 95209 PR0544775 <br /> March 24, 2021 <br /> PHOTO 3 : The client consent forms were not signed by the practitioner. <br /> 8Ye nht A approved and health consequences are unknown./'. <br /> I have read artd understand the contents of each paragraph above. I have received no unrealistic t' <br /> warranties or guarantt s with respect to the benefits to be realised from, or consequences of, the <br /> atbrententioned prtxedurv1. tiC-r <br /> Your signature below represents consent for permanent cosmetic servicqs and shall remain in effect <br /> during theentire period you remain a client of Aesthetics Lash Irik. (Init) <br /> Owle:dge by signing this consent form, I have been given full opportunity to ask any and all questions <br /> permanent makeup procedures and processes from my permanent makeup technician and/ or her <br /> Date t I / tLf l ZG <br /> reviewed the aboveinf�n with my client, or the client' s representative. <br /> Cosmetic Technician Date <br /> 1 � 1 <br /> Sandip Singh , REHS Page 3 of 3 <br />
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