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EHD Program Facility Records by Street Name
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5759
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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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of the potential risks associated with getting a tattoo I wish to proceed with the tattoo procedure and application and freely accept and <br /> expressly assume any and all risks that may arise from tattooing. (PLEASE INITIAL) <br /> Risk Notification and expectations following a tattoo procedure. <br /> -Body art can cause swelling,bruising,discomfort,bleeding,&pain.- Body art can cause allergic reactions.- Body art can cause irreversible changes <br /> to the human body.- Body art has a risk of infection.-Any effective removal of the body art work may leave permanent scarring and disfigurement <br /> I WAIVE AND RELEASE to the fullest extent permitted by law any person of the Tattoo Studio from all liability whatsoever,including but not <br /> limited to,any and all claims or causes of action that I,my estate, heirs,executors or assigns may have for personal injury or otherwise, <br /> including any direct and/or consequential damages,which result or arise from the procedure and application of my tattoo,whether caused by <br /> the negligence or fault of either the Tattoo Studio,or otherwise. (PLEASE INITIAL) <br /> The Tattoo Studio has given me the full opportunity to ask any question about the procedure and application of my tattoo and all of my <br /> questions have been answered to my satisfaction. (PLEASE INITIAL) <br /> The Tattoo Studio has given me instructions on the care of my tattoo while it's healing.I understand and will follow them. I acknowledge that <br /> it is possible that the tattoo can become infected,particularly if I do not follow the instructions given to me. If any touch-up work to the <br /> tattoo is needed due to my own negligence, I agree that the work will be done at my own expense. (PLEASE INITIAL) <br /> I am not under the influence of alcohol or drugs,and I am voluntarily submitting to be tattooed by the Tattoo Studio without duress or <br /> coercion. (PLEASE INITIAL) <br /> I am 18 years or older(PLEASE INITIAL) <br /> I do not suffer from diabetes, epilepsy, hemophilia, heart condition(s),nor do I take blood thinning medication. I do not have any other <br /> medical or skin condition that may interfere with the procedure,application or healing of the tattoo. I am not the recipient of an organ or bone <br /> marrow transplant or,if I am, I have taken the prescribed preventative regimen of antibiotics that is required by my doctor in advance of any <br /> invasive procedure such as tattooing or piercing. I am not pregnant or nursing.I do not have a mental impairment that may affect my <br /> judgement in getting the tattoo. (PLEASE INITIAL) <br /> I do not have a condition needing immunosuppressants- Crohn's Disease,Lupus,some skin conditions. (PLEASE INITIAL) <br /> I am not allergic to lidocaine,and consent to the use of a lidocaine solution as a numbing agent during the application of my tattoo. If you are <br /> allergic to lidocaine or do not want it to be used,please inform your tattoo artist prior to beginning the procedure. (PLEASE INITIAL) <br /> The Tattoo Studio is not responsible for the meaning or spelling of the symbol or text that I have provide to them or chosen from the flash <br /> (design) sheets.(PLEASE INITIAL) <br />
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