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COMPLIANCE INFO
Environmental Health - Public
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EHD Program Facility Records by Street Name
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4330
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4100 – Safe Body Art
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PR0547411
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COMPLIANCE INFO
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Entry Properties
Last modified
3/5/2025 11:41:33 AM
Creation date
6/27/2023 9:15:59 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4100 – Safe Body Art
File Section
COMPLIANCE INFO
RECORD_ID
PR0547411
PE
4120 - BODY ART FACILITY-SINGLE USE
FACILITY_ID
FA0024423
FACILITY_NAME
TATT ME UP STUDIO (PEREZ, ARMANDO)
STREET_NUMBER
4330
Direction
N
STREET_NAME
PERSHING
STREET_TYPE
AVE
City
STOCKTON
Zip
95207
CURRENT_STATUS
Active, billable
QC Status
Approved
Scanner
SJGOV\cfield
Supplemental fields
Site Address
4330 B-24 N PERSHING AVE STOCKTON 95207
Suite #
B-24
Tags
EHD - Public
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INFORMED CONSENT TO BODY ART WORK <br />In consideration of receiving BODY ART from the body <br />art Practitioner at TATT ME UP STUDIO. <br />(together with its employees, apprentices of "TATT ME UP STUDIO") <br />the following by initialing each <br />applicable item. <br />_ All questions about the Body Art work have been answered to my satisfaction, and I have been given written <br />and verbal aftercare instructions for the Body Art work I am about to receive. <br />The Body Art has been described or shown to me and is correctly placed or drawn to my specifications <br />_ I understand that tattooing is permanent and that if I choose to have it removed, it may be expensive and ieaea <br />scars. <br />_ I am the person on the legal ID presented as proof that I am at least 18 years of age; and in the case of a <br />minor receiving legal piercing, I am the legal parent or guardian of the minor receiving the legal piercing and I am <br />granting permission for this minor to receive the legal body piercing. <br />_ I am not under the influence of alcohol or drugs and that I am voluntarily submitting to Body Art work wit!�cj <br />� <br />duress or coercion. <br />Inks we use are not FDA approved and health consequences are still unknown. <br />I understand there is a possibility of an allergic reaction. <br />I understand there is a possibility of getting an infection. <br />_ I agree to follow all instructions concerning the care of my Body Art work, and that any touch-ups or repairs <br />that may become needed due to my own negligence will be done at my own expense. <br />I understand that there is a chance I might feel lightheaded or dizzy during or after Body Art work <br />_ I agree to immediately notify the artist in the event I feel lightheaded, dizzy and/or faint before, during or after <br />the procedure. <br />I, have been fully informed of the asks of Body Art including, <br />But, not limited to infection, scarring, difficulties in detecting melanoma, and allergic reactions to pigments, latex <br />gloves, and antibiotics. Having been informed of the potential risks associated with obtaining Body Art. I still wish <br />to proceed with the Body Art work and I assume any and all risks that may arise from the Body Art work. If while <br />n facility. If faint or get hurt we are not responsible for you or guest. <br />Dale <br />TATTOO PLACEMENT AND DESCRIPTION <br />
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