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COMPLIANCE INFO
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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1308
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4100 – Safe Body Art
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PR2500664
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COMPLIANCE INFO
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Entry Properties
Last modified
11/13/2025 8:50:38 AM
Creation date
10/20/2025 12:18:42 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4100 – Safe Body Art
File Section
COMPLIANCE INFO
RECORD_ID
PR2500664
PE
4120 - Single Use
FACILITY_ID
FA0004772
FACILITY_NAME
INKED ARCHES BY DINA (SHUJA, MADINA)
STREET_NUMBER
1308
Direction
W
STREET_NAME
MAIN
STREET_TYPE
ST
City
RIPON
Zip
95366
CURRENT_STATUS
Active, billable
QC Status
Approved
Scanner
SJGOV\cfield
Supplemental fields
Site Address
1308 D W MAIN ST RIPON 95366
Suite #
D
Tags
EHD - Public
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Certificate Of Completion <br />Envelope Id: 7F727F4C-F795-4CAB-BD47-9F510B204D38 Status: Completed <br />Subject: Documents for your DocuSign Signature <br />Source Envelope: <br />Document Pages: 3 Signatures: 2 Envelope Originator: <br />Certificate Pages: 2 Initials: 0 Michael McCann <br />AutoNav: Enabled <br />EnvelopeId Stamping: Enabled <br />Time Zone: (UTC-06:00) Central Time (US & Canada) <br />2355 Waukegan Road <br />Bannockburn, IL 60062 <br />michael.mccann@stericycle.com <br />IP Address: 155.226.129.249 <br />Record Tracking <br />Status: Original <br /> 9/4/2025 1:27:20 PM <br />Holder: Michael McCann <br /> michael.mccann@stericycle.com <br />Location: DocuSign <br />Signer Events Signature Timestamp <br />Madina Shuja <br />inkedarchesbydina@gmail.com <br />Owner- permanent makeup artist <br />Security Level: Email, Account Authentication <br />(None)Signature Adoption: Drawn on Device <br />Using IP Address: 2a09:bac2:66a9:123c::1d1:e2 <br />Signed using mobile <br />Sent: 9/4/2025 1:27:22 PM <br />Viewed: 9/4/2025 1:28:56 PM <br />Signed: 9/4/2025 1:29:37 PM <br />Electronic Record and Signature Disclosure: <br /> Not Offered via Docusign <br />Michael McCann <br />michael.mccann@stericycle.com <br />Inside Sales Representative <br />Stericycle <br />Security Level: Email, Account Authentication <br />(None) <br />Signature Adoption: Pre-selected Style <br />Using IP Address: 73.110.100.77 <br />Sent: 9/4/2025 1:29:39 PM <br />Viewed: 9/4/2025 1:30:13 PM <br />Signed: 9/4/2025 1:31:20 PM <br />Electronic Record and Signature Disclosure: <br /> Not Offered via Docusign <br />In Person Signer Events Signature Timestamp <br />Editor Delivery Events Status Timestamp <br />Agent Delivery Events Status Timestamp <br />Intermediary Delivery Events Status Timestamp <br />Certified Delivery Events Status Timestamp <br />Carbon Copy Events Status Timestamp <br />Witness Events Signature Timestamp <br />Notary Events Signature Timestamp <br />Envelope Summary Events Status Timestamps <br />Envelope Sent Hashed/Encrypted 9/4/2025 1:27:22 PM <br />Certified Delivered Security Checked 9/4/2025 1:30:13 PM <br />Signing Complete Security Checked 9/4/2025 1:31:20 PM
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