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EHD Program Facility Records by Street Name
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4100 – Safe Body Art
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PR2500160
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COMPLIANCE INFO
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Entry Properties
Last modified
5/19/2026 4:40:57 PM
Creation date
7/17/2025 1:28:56 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4100 – Safe Body Art
File Section
COMPLIANCE INFO
RECORD_ID
PR2500160
PE
4120 - BODY ART FACILITY - SINGLE USE
FACILITY_ID
FA0002635
FACILITY_NAME
LUX STUDIO ELUSIVE PMU & TATTOO (MONDRAGON, ALEKXIS)
STREET_NUMBER
3200
STREET_NAME
NAGLEE
STREET_TYPE
RD
City
TRACY
Zip
95304
CURRENT_STATUS
Inactive, non-billable
QC Status
Approved
Scanner
SJGOV\sballwahn
Supplemental fields
Site Address
3200 116 NAGLEE RD TRACY 95304
Suite #
#116
Tags
EHD - Public
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e� the <br /> Permanent Makeup a Tattoo <br /> CONSENT AND RELEASE AGREEMENT <br /> FOR PERMANENT COSMETIC PROCEDURE <br /> The Permanent Makeup Specialist,herein designated Specialist,who will be performing the requested permanent cosmetic procedure(s),and the <br /> undersigned client,herein designated Client,who will receive the permanent cosmetic procedure(s)are subject to the terms and conditions <br /> specified herein: <br /> This agreement to have a permanent cosmetic procedure is entered into by the Specialist and: <br /> Client's Name' <br /> Street Address <br /> City <br /> State <br /> Zip <br /> Email <br /> Phone Number <br /> AGREEMENT <br /> ACKNOWLEDGEMENT OF COMPLICATIONS ASSOCIATED WITH PERMANENT COSMETICS <br /> 1.The Client has been informed by the Specialist of possible risks.dangers,and complications associated with having a permanent cosmetic facial <br /> tattoo procedure performed.The Client acknowledges that these dangers may include:eye injury,allergies to any materials used in the process, <br /> fever-blisters and cold sores,swelling,bruising(although rare),temporary minor bleeding,redness,risk of spreading,fading,and fanning of pigment, <br /> and various other possible unintended or negative results of the procedure,some or all of which may not be desirable to the Client <br /> 2.Having been completely advised on all inherent risks,dangers.and complications associated with permanent cosmetic facial tattoo procedures. <br /> the Client hereby voluntarily assumes all risk of any possible negative result ensuing from the cosmetic procedures which are to be performed. <br /> 3.Client is aware that they must be 18 years of age or older to receive Permanent makeup Procedure. <br /> q.Client has been notified that all Permanent Cosmetic procedures are a permanent nature of procedure and can only be removed using Laser or <br /> saline removal.All removal costs are the clients responsibility. <br />
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