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SR0086964
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4100 – Safe Body Art
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SR0086964
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Entry Properties
Last modified
8/29/2023 11:30:43 AM
Creation date
8/29/2023 11:29:08 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4100 – Safe Body Art
File Section
COMPLIANCE INFO
RECORD_ID
SR0086964
PE
4103
FACILITY_NAME
MY SALON SUITE
STREET_NUMBER
5759
STREET_NAME
PACIFIC
STREET_TYPE
AVE
City
STOCKTON
Zip
95207
ENTERED_DATE
7/17/2023 12:00:00 AM
SITE_LOCATION
5759 PACIFIC AVE
QC Status
Approved
Scanner
SJGOV\cfield
Tags
EHD - Public
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Body Art Facility Infection Prevention And Control Plan Guideline <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)0)). <br />D..•iW.4. Wireless Tattoo u. VIRst Tour <br />U. Service Animals: Describe the facility's policy regarding service animal presence in procedure, <br />decontamination, and sterilization areas (California Health and Safety Code 119314 (f)). <br />Service Animals are allowed in the facility. Service animal must be controlled by owner and leashed. Leash must be held by <br />owner during procedure. The procedure area will be disinfected as usual by spraying disinfectant anywhere the service animal <br />u. •. - .--• • . • : �- .. . •-. .- a-� .-. _• .. � .- a-. , -. . • • . • - •. u. - <br />animals may be kept in container and set on the floor near owner. <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 />Signature: cAd Date: <br />07/15/2023 <br />Title: Owner 07/15/2023 <br />Page 8 of 11 <br />
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