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COMPLIANCE INFO
Environmental Health - Public
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EHD Program Facility Records by Street Name
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4100 – Safe Body Art
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PR0542033
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COMPLIANCE INFO
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Entry Properties
Last modified
3/8/2024 12:25:30 PM
Creation date
3/22/2021 9:48:39 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4100 – Safe Body Art
File Section
COMPLIANCE INFO
RECORD_ID
PR0542033
PE
4120
FACILITY_ID
FA0024127
FACILITY_NAME
LUMIERE SPA (CARRANZA, GEORGINA)
STREET_NUMBER
15
Direction
W
STREET_NAME
OAK
STREET_TYPE
ST
City
LODI
Zip
95240
CURRENT_STATUS
01
SITE_LOCATION
15 W OAK ST
P_LOCATION
02
QC Status
Approved
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SJGOV\cfield
Tags
EHD - Public
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r <br /> €x <br /> LAROE PORE IONSENT FORM <br /> 77 <br /> x <br /> Gk acknowledge by signing this agreement that I have been informed of the <br /> :rIsks, and possible complications when applying cosmetic tattoo (microblading)to oily skin or skin with <br /> �5 <br /> tend that microblading is a permanent cosmetic procedure. <br /> stand the microblading "hairstrokes" may expand from their original size due to oil underneath the skin <br /> x <br /> pores. <br /> s <br /> ledge that due to the unpredictable nature of oily skin (or skin with large pores) interacting with the <br /> process it is not reasonably possible for representatives of this establishment, <br /> to predict exactly how oily skin may affect the results of microblading. <br /> stand that visible results on the day of the appointment will change over time. Changes may include: <br /> ening, darkening, or changing of color, increase in thickness of "hairstrokes, fading of "hairstrokes." I <br /> acknowledge these changes may be more drastic due to the unpredictable nature of oily skin or skin with <br /> large pores. <br /> consent to the application of the cosmetic tattoo regardless of potential complications due to oily skin or <br /> skin with large pores. <br /> Client: Date: <br /> Practitioner: Date: <br /> 68 <br />
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