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S. Commercial Ink or Pigment Manufacturers: List the manufacturer for the inks or pigments <br /> used at the body art facility. Describe the procedure for dilution of inks. Only sterile water should <br /> be used for dilution of inks or pigments. (California Health and Safety Code 119311 (b)(c)(d)(e)) <br /> T. Permanent Cosmetic Machine Name and Manufacturer: Provide the model name and number <br /> for the permanent cosmetic machine used. (California Health and Safety Code 119311 (i)o)) <br /> U. Service Animals: Describe the facility's policy regarding service animals allowance in procedure <br /> or decontamination and sterilization areas. (California Health and Safety Code 119314 (f)) <br /> Maintain a copy of this document in your files. Submit one copy to the Local Enforcement Agency. <br /> I hereby certify that all body art practitioners performing body art at this facility and <br /> employees or individuals involved with decontamination and sterilization procedures have <br /> been trained with the procedures and information contained in this document and to the best <br /> of my knowledge and belief, the statements made herein are correct and true. <br /> Signature: Date: <br /> Page 6 of 10 <br />