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COMPLIANCE INFO
Environmental Health - Public
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EHD Program Facility Records by Street Name
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ACACIA
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32
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4100 – Safe Body Art
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PR0538749
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COMPLIANCE INFO
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Entry Properties
Last modified
4/25/2023 9:14:09 AM
Creation date
7/3/2020 10:13:36 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4100 – Safe Body Art
File Section
COMPLIANCE INFO
RECORD_ID
PR0538749
PE
4120
FACILITY_ID
FA0021596
FACILITY_NAME
WORD OF MOUTH TATTOO
STREET_NUMBER
32
Direction
E
STREET_NAME
ACACIA
STREET_TYPE
ST
City
STOCKTON
Zip
95202
CURRENT_STATUS
02
SITE_LOCATION
32 E ACACIA ST
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
Scanner
SJGOV\cfield
Supplemental fields
FilePath
\MIGRATIONS\BA\BA_4120_PR0538749_32 E ACACIA_.tif
Tags
EHD - Public
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Client record — Permanent Cosmetics and Tattooing Informed Consent <br /> Last Name First Name Date <br /> Address <br /> Street Apt. # City State Zip <br /> Date of Birth Location on Body Name of Practitioner <br /> COPY OR DESCRIPTION OF PERMANENT COSMETIC OR TATTOO <br /> I accept this design or procedure. Client Signature <br /> 1.D. I.D. <br /> Permanent Cosmetics and Tattooing Page 1 of 3 <br />
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