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SR0078807
Environmental Health - Public
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4100 – Safe Body Art
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SR0078807
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Last modified
9/5/2024 9:41:56 AM
Creation date
9/5/2024 9:40:44 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4100 – Safe Body Art
File Section
COMPLIANCE INFO
RECORD_ID
SR0078807
PE
4103
FACILITY_NAME
LODI MICRO CLINIC
STREET_NUMBER
755
Direction
S
STREET_NAME
FAIRMONT
STREET_TYPE
AVE
City
LODI
Zip
95240
APN
03308052
ENTERED_DATE
3/2/2018 12:00:00 AM
SITE_LOCATION
755 S FAIRMONT AVE STE E2
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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-0 <br /> Body Art Facility Section 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)o)). <br /> Cheyenne Hawk <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 /> Not allowed <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: 2/23/18 <br /> Title: Owner <br /> Page 8 of 11 <br />
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