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t <br /> k <br /> Street Address: <br /> 1201 E Atherton Drive apt 111 <br /> City: <br /> Manteca <br /> State and Zip Code <br /> k <br /> k <br /> 95337 <br /> i <br /> Phone Number: <br /> 5106505327 <br /> Emergency Contact (Name) <br /> jenee selsor <br /> Emergency Contact(Phone Number) <br /> 2093524504 <br /> Tattoo Information - Spelling of any words to be tattooed. <br /> Rell <br /> i <br /> Tattoo Information - location of tattoo on BODY <br /> Left arm <br /> All questions about the body art procedure have been answered to my satisfacti n, <br /> and I have been given written aftercare instructions for the procedure I am abo t <br /> to receive. <br /> jg <br /> The tattoo described or shown on the client record form is currently drawn to m <br /> specifications. <br /> I <br /> i <br />