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COMPLIANCE INFO
Environmental Health - Public
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EHD Program Facility Records by Street Name
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OAK
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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
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EHD - Public
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I did not get unrealistic guarantees regarding the expected results or the consequences of <br /> the said treatment. <br /> YES I NO <br /> By signing the Consent, I certify that I had a chance to ask about everything related to the <br /> implementation of treatment and that the Artist provided me with clear and comprehensi- <br /> ble answers to all my questions. <br /> YES I NO <br /> I have no other questions or objections. <br /> YES I NO <br /> I certify that I have read and fully understand the contents of this microblading consent. I <br /> understand the risks and alternatives involved in this procedure(s). I have had the opportu- <br /> nity to ask questions, and all of my questions have been answered. I authorize <br /> (name of Artist) as my Eyebrow Microblading <br /> Artist to perform on my body the Eyebrow Microblading procedure desired today. <br /> I confirm that I have read and understand this Consent Form and I agree to be bound by it. I <br /> agree that all the above information is true and accurate to the best of my knowledge. <br /> Client's Signature Date <br /> *If any other legal document is required by the government of the country of the Artist, it <br /> should be signed applied. <br />
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