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SR0086933
Environmental Health - Public
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4100 – Safe Body Art
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SR0086933
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Last modified
9/1/2023 11:30:45 AM
Creation date
9/1/2023 9:48:50 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4100 – Safe Body Art
File Section
COMPLIANCE INFO
RECORD_ID
SR0086933
PE
4103
FACILITY_NAME
LUXE BEAUTY LOFT LLC
STREET_NUMBER
1110
Direction
W
STREET_NAME
KETTLEMAN
STREET_TYPE
LN
City
LODI
Zip
95240
APN
06037002
ENTERED_DATE
7/10/2023 12:00:00 AM
SITE_LOCATION
1110 W KETTLEMAN LN
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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used at the body art facility. Describe the procedure for dilution of inks. Only sterile water should <br />be used for dilution of inks or pigments. (California Health and Safety Code 119311 (b)(c)(d)(e)) <br />Vex-mcuowck o o�ryuurr\ <br />tau 6 - �Xkun "� s4 <br />—Vok .4-D ckbso o jn ,-- <br />C� Vrn 5W oco <br />-PC5!A c yi U 0— <br />T. Permanent Cosmetic Machine Name and Manufacturer: Provide the model name and number <br />for the permanent cosmetic machine used. (California Health and Safety Code 119311 (i)Q)) <br />U. Service Animals: Describe the facility's policy regarding service animals allowance in procedure <br />or decontamination and sterilization areas. (California Health and Safety Code 119314 (f)) <br />Maintain a copy of this document in your files. Submit one copy to the Local Enforcement Agency. <br />1 hereby certify that all body art practitioners performing body art at this facility and <br />employees or individuals involved with decontamination and sterilization procedures have <br />been trained with the procedures and information contained in this document and to the best <br />of my knowledge and belief, the statements made herein are correct and true. <br />Signature: Date: I o T 3 <br />P, cjNk-ult <br />
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