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Environmental Health - Public
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EHD Program Facility Records by Street Name
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KETTLEMAN
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1110
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4100 – Safe Body Art
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PR0542329
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COMPLIANCE INFO
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Last modified
6/15/2023 8:55:39 AM
Creation date
7/3/2020 10:14:05 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4100 – Safe Body Art
File Section
COMPLIANCE INFO
RECORD_ID
PR0542329
PE
4120
FACILITY_ID
FA0024314
FACILITY_NAME
THE FRECKLED ROSE TATTOO (BRYANT, DANIEL)
STREET_NUMBER
1110
Direction
W
STREET_NAME
KETTLEMAN
STREET_TYPE
LN
City
LODI
Zip
95242
CURRENT_STATUS
02
SITE_LOCATION
1110 W KETTLEMAN LN STE 20B
P_LOCATION
02
QC Status
Approved
Scanner
SJGOV\cfield
Supplemental fields
FilePath
\MIGRATIONS\BA\BA_4120_PR0542329_1110 W KETTLEMAN_.tif
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EHD - Public
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Body Art Facility Infection Prevention And Control Plan Guideline <br /> T. Permanent Cosmetic Machine Name and Manufacturer: Provide the model name and number <br /> for the permanent cosmetic machine(s)used(California Health and Safety Code 119311 (i)a)). <br /> U. Service Animals: Describe the facility's policy regarding service animal presence in procedure, <br /> decontamination,and sterilization areas(California Health and Safety Code 119314(f)). <br /> Maintain a copy of this completed document in your files. Submit one copy to the Local Enforcement <br /> Agency. <br /> I hereby certify that all body art practitioners performing body art at this facility and employees <br /> or individuals involved with decontamination and sterilization procedures have been trained with <br /> the procedures and information contained In this document. To the best of my knowledge and <br /> belief, the statements made herein are correct and true. <br /> Signature: "® Date: _ <br /> Title <br /> P 1( Gi P, <br /> e l m0.\er <br /> Page 8 of 11 <br />
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