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EHD Program Facility Records by Street Name
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4100 – Safe Body Art
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PR0524524
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COMPLIANCE INFO
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Entry Properties
Last modified
3/20/2026 10:06:47 AM
Creation date
7/3/2020 10:15:18 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4100 – Safe Body Art
File Section
COMPLIANCE INFO
RECORD_ID
PR0524524
PE
4120 - BODY ART FACILITY-SINGLE USE
FACILITY_ID
FA0016445
FACILITY_NAME
HARD LUCK TATTOO (NGUYEN, BAO)
STREET_NUMBER
1
Direction
W
STREET_NAME
PINE
STREET_TYPE
ST
City
LODI
Zip
95240
CURRENT_STATUS
Active, billable
QC Status
Approved
Scanner
SJGOV\cfield
Supplemental fields
FilePath
\MIGRATIONS\BA\BA_4120_PR0524524_1 W PINE_.tif
Site Address
1 W PINE ST LODI 95240
Tags
EHD - Public
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In consideration of receiving a Tattoo from (Name of Artist) <br /> at(Name of Studio/Shop) Hard Luck Tattoo together with it's <br /> employees, apprentices, and independent agents or guests of the "studio/shop," in the county <br /> of San Joaquin , within the State of <br /> California , I AGREE TO THE FOLLOWING <br /> That I, (clearly PRINT your name)have been fully informed of the inherent risk, <br /> 0 associated with getting a tattoo. I fully understand that these risk, known and unknown, can lead to <br /> injury, including but not limiting to infection, scaring, difficulties in detecting melanoma and allergic <br /> reactions to tattoo pigments, latex gloves(we use nitrile gloves), and/or soap. Having been informed of <br /> the potential risks associated with getting a tattoo, I still wish to proceed with the tattoo application and I <br /> freely accept and expressly assume any and all risk that may arise from this action. <br /> Initial <br /> 0 TO WAIVE AND RELEASE to the fullest extent permitted by law ARTIST and the "Studio"from all liability <br /> whatsoever,for any and all claims or cause of action that 1, my estates, heirs, executors, or assigns may <br /> have for personal injury or otherwise, including any direct and/or consequential damages,which result or <br /> arise from the application from my tattoo,whether caused by the negligence or fault of either the <br /> Initial ARTIST, STUDIO, or otherwise. <br /> OThe ARTIST and the Studio have given me the full opportunity to ask any and all questions about the <br /> application of my tattoo procedure and all of my questions have been answered to my total satisfaction <br /> Initial <br /> O The Artist and the Studio have given me instructions on the care of my tattoo or piercing while it's <br /> healing, and I understand them and will follow them. I acknowledge that it is possible that the tattoo can <br /> become infected particularly if I do not follow the instructions given to me. I agree that it is my <br /> responsibility to contact the Studio,Artist if there are signs and symptoms of infection, including, but not <br /> limited to, redness,swelling,tenderness of the procedure site, red streaks going from the procedure site <br /> towards the heart, elevated body temperature, or purulent drainage from the procedure site If any touch- <br /> Initial up work to the tattoo is needed due to my own negligence, I agree that the work will be done at my own <br /> expense. <br /> I am not under the influence of alcohol or drugs, and I am voluntarily submitting to be tattooed by the <br /> Artist without duress or coercion. <br /> Initial <br /> do not have diabetes,epilepsy, history of hemophilia or other bleeding disorders, history of herpes infection at the <br /> O procedure site, history of cardiac valve disease, nor do 1 take blood thinning medication.Other risk factors for <br /> bloodborne pathogens. I do not have any other medical or skin condition that may interfere with the application or <br /> healing of the tattoo. I am not the recipient of an organ or bone marrow transplant or, if I am, I have taken the <br /> prescribed preventive regimen of anti-biotics that is required by my doctor in advance of any invasive procedure such <br /> as tattooing. I am not pregnant or nursing. I do not have a mental impairment that may affect my judgment in getting <br /> the tattoo. I do not have allergic reactions to latex. I do not have a history of allergic reactions to antibiotics,nor do I <br /> Initial require antibiotics prior to surgery or dental procedures. <br />
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