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COMPLIANCE INFO_INACT
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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PR0537532
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COMPLIANCE INFO_INACT
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Last modified
4/20/2023 12:46:07 PM
Creation date
4/5/2023 2:12:15 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4100 – Safe Body Art
File Section
COMPLIANCE INFO
RECORD_ID
PR0537532
PE
4120
FACILITY_ID
FA0021603
FACILITY_NAME
WRONG SIDE OF THE TRACKS TATTOO (BROCKMAN, A)
STREET_NUMBER
512
Direction
N
STREET_NAME
UNION
STREET_TYPE
RD
City
MANTECA
Zip
95337
CURRENT_STATUS
02
SITE_LOCATION
512 N UNION RD
P_LOCATION
04
P_DISTRICT
001
QC Status
Approved
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EHD - Public
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iercing Contract <br /> 12. 1 will disclose any information ilia or bleeding disorders- <br /> 119303 (b)2_ <br /> 13. 1 will disclose any history of cardiacvalvedisease-119303 ( ) <br /> . Current medications you are . - ( ) <br /> 15. 1 will disclose all requirements i itics prior to surgery or <br /> dental procedures-119303 O _ <br /> 16. 1 will disclose any other risk factors for bloodore pathogens- <br /> 119303 (b)4_ <br /> 17. 1 agree to assume the risk of possibleinjury, allergic reaction or <br /> disease that may occur as a result of thisprocedure Y / <br /> 18. This procedure on your skin is not permanent, it could cause a scare. <br /> Is that ok withyou? <br /> -119303 ( ) 3 Y / <br /> 19. 1 understand the success of my Piercingends not only upon the <br /> skill of the technician, but upon the aftercare1 give myself. Upon <br /> receiving written and oral instructions y piercing aftercarefrom <br /> the technician and leave the shop, I am fullyresponsible for it's care. <br /> . 1 understand that healing time ers person Y / <br />
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