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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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5.Client has been informed that permanent cosmetic inks or pigments are not FDA approved and the health consequences are unknown. <br /> 6.Procedure Description.A sterilized needle and cosmetic machine Is used to create small pixilation dots of ink under the first layer of your skin.The <br /> procedure is semi invasive and you are giving a topical numbing agent throughout the procedure. <br /> Client's Initials <br /> Client's Initials <br /> RESULTS <br /> The client agrees to accept full responsibility for the color,shape,and thickness of each and every procedure executed by the Specialist,to include <br /> but not limited to eyebrow Microblading or Powderfill/SoftTap technique,or any other permanent cosmetic procedure. <br /> Client's Initials <br /> DISPUTE RESOLUTION <br /> The client agrees that in the event of a dispute between the Client and the Specialist involving the services rendered under this agreement and any <br /> damages related thereto,and in the event that legal action is taken,the parties shall be limited to resolving their dispute through action in a small <br /> claims court <br /> Client's Initials <br /> RECEIPT OF PRE-PROCEDURE AND POST-PROCEDURE INFORMATION <br /> The Client acknowledges receipt of pre-procedure information and post-procedure(aftercare)instructions from the Specialist,and agrees that they <br /> have read them,have been advised of them,understand them,and agree to adhere to them in order to help ensure satisfactory results from the <br /> procedure(s)and help prevent secondary infection.The Client acknowledges that all final adjustments and detail work will be done in the second <br /> session,and will schedule a follow-up session with the Specialist within 4-6 weeks of the procedure(s). <br /> Client's Initials <br /> CONSENTOF PERMANENT COSMETIC PROCEDURE <br /> The client fully,and voluntarily,consents to have the Specialist perform the permanent cosmetic procedure(s),and is fully aware and informed of all <br /> and any Inherent risks,dangers,and complications associated with having permanent cosmetic facial tattoo procedures performed.The client has <br /> had any questions or concerns which he/she has expressed satisfactorily answered or resolved by the Specialist. <br /> Client's Initials <br /> RELEASE OF CLAIMS <br /> The Client,realizing that cosmetic procedures of the type of those specified in this agreement are fraught with risks and dangers which cannot be <br /> eliminated from the process regardless of the precautions and safeguards which are undertaken,hereby agrees that the client releases the <br /> Specialist from any and all claims,damages,and liability of all types relating to the performance of the specified procedure(s),including any costs of <br /> medical care or assistance required by the Client as a result of the procedure(s)performed,which shall include any post-operative care,repair or <br /> reconstruction which the Client may require or desire.This release agreement by the client shall also extend to the proprietors,officers,agents,and <br /> employees of any business Specialist that is employed by or associated with performing the cosmetic procedure(s). <br /> Cfient's Initials <br /> IN WITNESS HEREOF,Client and Spedatist do hereby give their assent to the terms of this Agreement on the date entered. <br /> Signature <br />
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