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COMPLIANCE INFO
Environmental Health - Public
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4100 – Safe Body Art
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PR0537807
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COMPLIANCE INFO
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Entry Properties
Last modified
5/5/2023 3:27:56 PM
Creation date
3/30/2023 1:03:06 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4100 – Safe Body Art
File Section
COMPLIANCE INFO
RECORD_ID
PR0537807
PE
4120
FACILITY_ID
FA0021685
FACILITY_NAME
TELEIOS TATTOO STUDIO (HIRSCHLER, DANIEL M)
STREET_NUMBER
21
Direction
S
STREET_NAME
SACRAMENTO
STREET_TYPE
ST
City
LODI
Zip
95240
CURRENT_STATUS
02
SITE_LOCATION
21 S SACRAMENTO ST
QC Status
Approved
Scanner
SJGOV\cfield
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EHD - Public
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In consideration of receiving Body Art at Teleios Tattoo (together with its <br />employees, apprentices, and agents, the Body Art Business) <br />I., — confirm the following by initialing each <br />applicable item: <br />— All questions about the body art procedure have been answered to my <br />satisfaction, and I have been given written aftercare instructions for the <br />procedure I am about to receive. <br />I understand that tattooing is permanent and that if I choose to have it <br />removed it may leave scarring. <br />11,111''iEs Tig M MWO =00's AGE, <br />i I I III I• <br />I am not under the influence of alcohol or drugs and that I am voluntarily <br />submitting to be tattooed without duress or coercion. <br />ME= <br />M T MUM M01 <br />I understand the FDA has not approved any tattoo ink, and there is no specifij <br />requirement that explicitly says tattoo inks must be sterile. <br />— I agree to follow all instructions concerning the care of my tattoo and th <br />any touch-ups needed due to my own negligence will be done at my expensi <br />— I agree to immediately notify the artist in the event of feeling dizzy or faint <br />before, during, or after the procedure. <br />
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