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4100 – Safe Body Art
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PR0548626
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COMPLIANCE INFO
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Entry Properties
Last modified
5/7/2026 2:42:03 PM
Creation date
4/3/2025 11:46:04 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4100 – Safe Body Art
File Section
COMPLIANCE INFO
RECORD_ID
PR0548626
PE
4120 - BODY ART FACILITY-SINGLE USE
FACILITY_ID
FA0026472
FACILITY_NAME
ADORN ME TATTOO (BOU, JENNIFER)
STREET_NUMBER
5759
STREET_NAME
PACIFIC
STREET_TYPE
AVE
City
STOCKTON
Zip
95207
CURRENT_STATUS
Active, billable
QC Status
Approved
Scanner
SJGOV\sballwahn
Supplemental fields
Site Address
5759 B145 PACIFIC AVE STOCKTON 95207
Suite #
B145
Tags
EHD - Public
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TATTOOADORN ME <br /> 5759 PACIFIC AVE, STOCKTON, CA 95207 <br /> PLEASE INITIAL IN THE BOXES PROVIDED AFTER READING TO SHOW THAT YOU UNDERSTAND EACH PROVISION. FEEL FREE TO ASK <br /> ANY QUESTIONS REGARDING THIS WAIVER. <br /> In consideration of receiving a tattoo from ADORN BEAUTY INK LLC including its artists,associates, apprentices,agents,or any employees <br /> (hereinafter referred to as the"Tattoo Studio' I agree to the following: <br /> Name <br /> First Name Last Name <br /> I have been fully informed of the risks associated with getting a tattoo. I fully understand that these risks, known and unknown, can <br /> lead to injury including but not limited to: infection,scarring,difficulties in the detection of melanoma and allergic reactions to <br /> tattoo pigment,aftercare products and/or soap. Body art can cause swelling, bruising,discomfort, bleeding,and pain. Body art can <br /> cause irreversible changes to the human. Body art can cause allergic reactions. Inks are not FDA approved and health <br /> consequences are unknown. Having been informed of the potential risks associated with getting a tattoo I wish to proceed with the <br /> tattoo procedure and application and freely accept and expressly assume any and all risks that may arise from tattooing. (PLEASE <br /> INITIAL) <br /> Risk Notification: <br /> - Body art can cause swelling,bruising, discomfort,bleeding, &pain. - Body art can cause allergic reactions. - Body art can cause irreversible <br /> changes to the human body.- Body art has a risk of infection. -Any effective removal of the body art work may leave permanent scarring and <br /> disfigurement <br /> 1 WAIVE AND RELEASE to the fullest extent permitted by law any person of the Tattoo Studio from all liability whatsoever, <br /> including but not limited to,any and ail claims or causes of action that I, my estate, heirs, executors or assigns may have for <br /> personal injury or otherwise, including any direct and/or consequential damages,which result or arise from the procedure and <br /> application of my tattoo,whether caused by the negligence or fault of either the Tattoo Studio,or otherwise. (PLEASE INITIAL) <br /> https://formJottorm.com/231451B78214154 5/12/25, 2:10AM <br /> Page 1 of 9 <br />
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