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COMPLIANCE INFO_VICTOR LARA
Environmental Health - Public
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4100 – Safe Body Art
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PR0537130
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COMPLIANCE INFO_VICTOR LARA
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Entry Properties
Last modified
6/4/2024 11:27:50 AM
Creation date
7/3/2020 10:15:04 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4100 – Safe Body Art
File Section
COMPLIANCE INFO
RECORD_ID
PR0537130
PE
4121
FACILITY_ID
FA0021313
FACILITY_NAME
TRUE CLASSIC TATTOO (LARA, VICTOR R)
STREET_NUMBER
423
Direction
E
STREET_NAME
MINER
STREET_TYPE
AVE
City
STOCKTON
Zip
95202
APN
13924018
CURRENT_STATUS
01
SITE_LOCATION
423 E MINER AVE
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
Scanner
SJGOV\cfield
Supplemental fields
FilePath
\MIGRATIONS\BA\BA_4121_PR0537130_423 E MINER_.tif
Tags
EHD - Public
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RELEASE AND CONSENT TO TATTOO <br /> THIS DOCUMENT|STWO PAGES��Two O�ed[ PLEASE\N[OALEACH PRO�8|C}NOV� <br /> � <br /> THE LINES PRODEDAFTER 'READING TO SHOW THAT YOU UNDERSTAND EACH <br /> PROVISION. <br /> |nconsideration ofreceiving atattoo from/ }(the^Artiat">at[TRUE CLASSIC <br /> TATTOO](together with its employees, apprentices and agents, the"Tattoo Studio"), I agree to <br /> the following: <br /> That 1, (clearly PRINT your name)have <br /> --� <br /> fully understand that these risks,*known and unknown,can lead mminjury, <br /> ' <br /> including but not limited to infection,scarring,difficulties In detecting <br /> melanoma and allergic reactions tmtattoo pigment, latex gloves,and/or soap. <br /> Having been informed of the potential risks associated with getting atattoo,1 <br /> still wish toproceed with the tattoo application and I freely accept and <br /> expressly assume any and all risks that may arise from tattooing. <br /> TO WAIVE AND RELEASE to the fullest extent permitted by law each of the Artist <br /> and the Tattoo Studio from all liability whatsoever, for any and all claims or causes <br /> of action that 1, my estate, heirs, executors or assigns may have for personal injury <br /> or otherwise, including any direct and/or consequential damages,which result or <br /> arise from the application of my tattoo,whether caused by the negligence or fault of <br /> either the Artist orthe Tattoo Studio, orotherwiee. <br /> That both the Artist and the Tattoo Studio have given me the full opportunity to ask <br /> any and all questions about the application ofmytattoo and all ofmyquestions <br /> --'—�� <br /> have been answered 0ornytotal satisfaction. <br /> The Artist and the Tattoo Studio have given me instructions on the care of my <br /> tattoo while it's healing, and I understand them and will follow them. I acknowledge <br /> � ^~--~----� <br /> that it is possible that the tattoo can become infected, particularly if I do not follow <br /> | <br /> the instructions given to me. If any touch-up work to the tattoo is needed due to my <br /> i <br /> own negligence, | agree that the work w/iU'bedone otmyown expense. <br /> I am not under the influence of alcohol or drugs, and I am voluntarily submitting to <br /> � betattooed bythe Artist without duress orcoercion. <br /> ! <br /> I do not have diabetes, epilepsy, hemophilia, a heart condition, nor do I take blood <br /> ! <br /> thinning medication. I do not have any other medical or skin condition that may <br /> � ^--------~ <br /> interfere with the application or healing of the tattoo. I am not the recipient of an <br /> orbunernernJ�tnansp|ootor �| ann \ have tahenthe pnesohbadpravenUve <br /> � organ . . <br /> �-- zf �nt-bkocothmti� naquinsdbynnydooborinadvonceofonyinvasvo <br /> '-"--' - <br /> procedure such as tattooing | ornnot pregnant ornursing. | donot have <br /> mental impairment that may affect myjudgment ingetting the tattoo. <br /> Neither the Artist nor the Tattoo Studio ksresponsible for the meaning ¢rspelling of <br /> the symbol or text that I have provided to them or chosen from the flash (design) <br /> sheets. <br /> ' <br />
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