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COMPLIANCE INFO_VICTOR LARA
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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4100 – Safe Body Art
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PR0537130
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COMPLIANCE INFO_VICTOR LARA
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Entry Properties
Last modified
1/15/2026 11:10:01 AM
Creation date
7/3/2020 10:15:04 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4100 – Safe Body Art
File Section
COMPLIANCE INFO
RECORD_ID
PR0537130
PE
4120 - BODY ART FACILITY - SINGLE USE
FACILITY_ID
FA0021313
FACILITY_NAME
TRUE CLASSIC TATTOO (LARA, VICTOR R)
STREET_NUMBER
423
Direction
E
STREET_NAME
MINER
STREET_TYPE
AVE
City
STOCKTON
Zip
95202
APN
13924018
CURRENT_STATUS
Active, billable
QC Status
Approved
Scanner
SJGOV\cfield
Supplemental fields
FilePath
\MIGRATIONS\BA\BA_4121_PR0537130_423 E MINER_.tif
Site Address
423 E MINER AVE STOCKTON 95202
Tags
EHD - Public
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E:= 1 release all rights to any photographs taken of me and the piercing and give <br /> consent in advance to their reproduction in print or electronic form. (if you do not <br /> initial this provision, please advise and remind your Artist and the Piercing Studio <br /> NOT to take any pictures of you and your completed piercing!). <br /> I acknowledge that I have been given adequate opportunity to read and understand <br /> this document,that it was not presented to me at the last minute, and I understand <br /> that I am signing a legal contract waiving certain rights to recover against Piercing <br /> Studio. <br /> I agree to reimburse each of the Artist and the Piercing Studio for any attorneys' <br /> fees and costs incurred in any legal action I bring against either the Artist or the <br /> Piercing Studio and in which either the Artist or the Piercing Studio is the prevailing <br /> party. I agree that the that the courts of[CALIFORNIA]in[SAN JOAQUIN <br /> COUNTY]shall have personal jurisdiction and venue over me and shall have <br /> exclusive jurisdiction for the purpose of litigating any dispute arising out of or <br /> related to this agreement. <br /> I acknowledge that I have been given adequate opportunity to read and understand <br /> this document,that it was not presented to me at the last minute, and I understand <br /> that I am signing a legal contract waiving certain rights to recover against the Artist <br /> and the Piercing Studio. <br /> If any provision, section, subsection, clause or phrase of this release is found to be unenforceable <br /> or invalid, that portion shall be severed from this contract.The remainder of this contract will then <br /> be construed as though the unenforceable portion had never been contained in this document. <br /> I hereby declare that I am of legal age(and have provided valid proof of age)and am competent <br /> to sign this Agreement or, if not, that my parent or legal guardian shall sign on my behalf, and that <br /> my parent or legal guardian is in complete understanding and concurrence with this agreement. <br /> Description of procedure <br /> I HAVE READ THIS AGREEMENT,I UNDERSTAND IT, I AGREE TO BE BOUND BY IT. <br /> Print Full Name: Date of <br /> Birth: <br /> Address: Telephone: <br /> Signature of Date: <br /> Participant <br /> Signature of Parent or Guardian If Participant Is a Minor <br /> and by their signature they, on my behalf, release all claims that both they and I have. <br /> Signature: Date: <br />
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