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EHD Program Facility Records by Street Name
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ELEVENTH
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4100 – Safe Body Art
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PR0539015
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COMPLIANCE INFO
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Entry Properties
Last modified
11/19/2024 10:21:04 AM
Creation date
6/13/2023 1:18:13 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4100 – Safe Body Art
File Section
COMPLIANCE INFO
RECORD_ID
PR0539015
PE
4120
FACILITY_ID
FA0021597
FACILITY_NAME
FOREVER YOURS TATTOO (HULLAR, JOHN J)
STREET_NUMBER
606
Direction
W
STREET_NAME
ELEVENTH
STREET_TYPE
ST
City
TRACY
Zip
95376
APN
23502302
CURRENT_STATUS
02
SITE_LOCATION
606 W 11TH ST
P_LOCATION
03
P_DISTRICT
005
QC Status
Approved
Scanner
SJGOV\cfield
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EHD - Public
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C05 <br /> FOREVER YOURS TATrOO STUDIO <br /> Consent to Tattoo Release and Lia ilio waiver of all Claims. <br /> El I acknowledge that it is not possible for thea or employees at Forever Yours Tattoo Studio to <br /> determine whether or not I might have an allergic reaction to any of the materials used during the <br /> procedure.I accept the risk that a reaction is possible,and will not hold Forever Yours Tattoo Studio <br /> artist or employees responsible if a reaction should occur. <br /> El I acknowledge that an infection Is always possible.In the event that an infection should occur I will not <br /> hold Forever Yours Tattoo Studio,Its employees or anyone associated with Forever Yours Tattoo Studio <br /> liable for any problems or any expensive that does occur if an infection should arise. <br /> El I agree to hold harmless Forever Yours Tattoo Studio,its employees or anyone associated with Forever <br /> Yours Tattoo Studio from all claims and or legal action arising from or connected to the tattoo,or in any <br /> way related to the tattoo or the procedure and products used during the tattoo. <br /> n I acknowledge that aftercare instructions have been given to me,I have read and understood them and <br /> I have no further questions. <br /> El I acknowledge that I have been informed that tattoo in its nature is a permanent marking on the skin. <br /> o it is not very easily removed without considerable financial cost and discomfort to the client <br /> and in most case it Is not possible to permanently remove a tattoo <br /> El I acknowledge by signing this form that all of the information on this release is true and correct.I am <br /> obtaining my tattoo of my own free will and that all of my questions have been answered to my <br /> satisfaction. <br /> Name: D.O.8 <br /> Address: <br /> Phone# <br /> Signature: Date <br /> Artist procedure will consist of drawing a sketch out desired drawing and upon tattooing,the artist <br /> will put on fresh gloves to sanitize their station.They will let it dry for 15 minutes,in the mean time the <br /> artist will change gloves to wash and shave and stencil the desired area,let dry for 10 min The artist <br /> with then apply new gloves to set up station with dispossaW film and drape.Once the station is set up, <br /> the artist will wash hands and sanitize.He will then put on fresh gloves to do procedure. <br /> PICTURE ID IS REQUIRED date <br />
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