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SR0087001
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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SR0087001
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Entry Properties
Last modified
9/1/2023 11:28:31 AM
Creation date
9/1/2023 9:50:15 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4100 – Safe Body Art
File Section
COMPLIANCE INFO
RECORD_ID
SR0087001
PE
4103
FACILITY_NAME
MY SALON SUITES
STREET_NUMBER
5759
STREET_NAME
PACIFIC
City
STOCKTON
Zip
95207
ENTERED_DATE
7/27/2023 12:00:00 AM
SITE_LOCATION
5759 PACIFIC B145
QC Status
Approved
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SJGOV\cfield
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EHD - Public
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Body Art Facility Infection Prevention And Control Plan Guideline <br />T. Permanent Cosmetic Machine Name and Manufacturer: Provide the model name and number <br />for the permanent cosmetic machine(s) used (California Health and Safety Code 119311 (i)Q)). <br />Xion mini, bishop packer and mast tour. <br />U. Service Animals: Describe the facility's policy regarding service animal presence in procedure, <br />decontamination, and sterilization areas (California Health and Safety Code 119314 (f)). <br />Service animals are allowed in procedure area. <br />Maintain a copy of this completed document in your files. Submit one copy to the Local Enforcement <br />Agency. <br />I hereby certify that all body art practitioners performing body art at this facility and employees <br />or individuals involved with decontamination and sterilization procedures have been trained with <br />the procedures and information contained in this document. To the best of my knowledge and <br />belief, the statements made herein are correct and true. <br />Signature: Date: <br />Title: TG�CTO U �(r17 <br />Page 8 of 11 <br />
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