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0 <br />r • rr r • W-0 • M. <br />T. Permanent Cosmetic Machine Name and Manufacturer: Provide the model name and number <br />for the permanent cosmetic machine(s) used (California Health and Safety Code 119311 (i)a)). <br />U. Service Animals: Describe the ity's policy regarding service animal presence in procedure, <br />decontamination, and sterilization areas (California Health and Safety Code 119314 (f)). <br />Maintain a copy of this completed document in your files. Submit one copy to the Local Enforcement <br />Agency. <br />I hereby certify that all body art practitioners performing body art at this facility and employees <br />or individuals involved with decontamination and sterilization procedures have been trained with <br />the procedures and information contained in this document To the best of my knowledge and <br />belief, the statements made herein are correct and true <br />-Signatur : Date: <br />Title: <br />Page 8 of 11 <br />