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COMPLIANCE INFO_JOSE DIAZ
EnvironmentalHealth
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4100 – Safe Body Art
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PR0537587
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COMPLIANCE INFO_JOSE DIAZ
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Entry Properties
Last modified
7/11/2025 2:09:25 PM
Creation date
5/19/2023 2:47:38 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4100 – Safe Body Art
File Section
COMPLIANCE INFO
RECORD_ID
PR0537587
PE
4110 - BODY ART PRACTITIONER REGISTRATION
FACILITY_ID
FA0025055
FACILITY_NAME
TAT ME UP STUDIO (DIAZ, JOSE)
STREET_NUMBER
4330
Direction
N
STREET_NAME
PERSHING
STREET_TYPE
AVE
City
STOCKTON
Zip
95207
CURRENT_STATUS
Active, billable
QC Status
Approved
Scanner
SJGOV\cfield
Supplemental fields
Site Address
4330 B24 N PERSHING AVE STOCKTON 95207
Suite #
B24
Tags
EHD - Public
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WAIVER, RELEASE AND CONSENT TO TATTOO <br /> THIS DOCUMENT IS TWO PAGES. PLEASE INITIAL EACH PROVISION ON THE LINES PROVIDED AFTER READING TO <br /> SHOW THAT YOU UNDERSTAND EACH PROVISION. <br /> In consideration of receiving a tattoo from (the "Artist") and <br /> Grape City Tattoo(and its employees,apprentices and agents, here and after collectively referred to as <br /> "the Grape Studio"), I agree to the following: <br /> I, (clearly PRINT your name) have been fully informed of <br /> the inherent risks,associated with getting a tattoo. I fully understand that these risks, known <br /> and unknown,can lead to injury,including but not limited to infection,scarring,difficulties in <br /> detecting melanoma and allergic reactions to tattoo pigment,latex gloves,and/or soap. <br /> Having been informed of the potential risks associated with getting a tattoo, I still wish to <br /> proceed with the tattoo application and I freely accept and expressly assume any and all risks <br /> that may arise from tattooing. <br /> I WAIVE AND RELEASE to the fullest extent permitted by law each of the Artist and the Grape <br /> Studio from all liability whatsoever,for any and all claims or causes of action that I, my estate, <br /> heirs,executors or assigns may have for personal injury or otherwise, including any direct <br /> and/or consequential damages,which result or arise from the application of my tattoo,whether <br /> caused by the negligence or fault of either the Artist or the Tattoo Studio,or otherwise. <br /> Both the Artist and the Grape Studio have given me the full opportunity to ask any and all <br /> questions about the application of my tattoo and all of my questions have been answered to my <br /> total satisfaction. <br /> The Artist and Grape Studio have given me instructions on the care of my tattoo while it's <br /> healing,and I understand them and will follow them. I acknowledge that it is possible that the <br /> tattoo can become infected, particularly if I do not follow the instructions given to me. If any <br /> touch-up work to the tattoo is needed due to my own negligence, I agree that the work will be <br /> done at my own expense. <br /> I am not under the influence of alcohol or drugs,and I am voluntarily submitting to be tattooed <br /> by the Artist without duress or coercion. <br /> I do not have diabetes, epilepsy, hemophilia,a heart condition, nor do I take blood thinning <br /> medication. I do not have any other medical or skin condition that may interfere with the <br />
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