Contra Costa Environmental Health Division Body Arts Practitioner Application Completed Form Examples and Samples
View a detailed, filled-out example of the Contra Costa Environmental Health Division Body Arts Practitioner Application. Our sample form provides a clear guide for tattoo artists and piercers on how to correctly complete their initial or renewal registration.
Contra Costa Body Arts Practitioner Application Example
How this form was filled:
This is a sample of a completed Body Arts Practitioner Application for an initial registration in Contra Costa County. It includes the applicant's personal information, the body art facility where they will work, proof of required Bloodborne Pathogens training, and confirmation of Hepatitis B vaccination status.
Information used to fill out the document:
- Practitioner Full Name: Olivia Mei Chen
- Date of Birth: 06/10/1998
- Mailing Address: 123 Oak Grove Rd, Walnut Creek, CA 94598
- Phone Number: 925-555-1234
- Email Address: [email protected]
- Application Type: Initial Application
- Application Date: 03/15/2026
- Body Art Facility Name: Artful Ink Studio
- Facility Address: 456 Main St, Concord, CA 94520
- Services Provided: Tattooing
- Bloodborne Pathogens Training Provider: SafePro Training
- Training Completion Date: 02/20/2026
- Hepatitis B Vaccination Status: Completed Series
- Government ID Type: CA Driver's License
- Government ID Number: D1234567
What this filled form sample shows:
- Clearly marked as an Initial Application for a new practitioner.
- Contains complete practitioner personal information and contact details.
- Specifies the Body Art Facility name and address where the practitioner will work.
- Includes up-to-date Bloodborne Pathogens (BBP) training information, as required annually.
- Confirms the practitioner's Hepatitis B vaccination status, a key health requirement.
- The form is properly signed and dated for submission in the current year.
Form specifications and details:
| Form Name: | Contra Costa Environmental Health Division Body Arts Practitioner Application |
| Governing Body: | Contra Costa Environmental Health |
| Jurisdiction: | Contra Costa County, California, USA |
| Use Case: | Initial registration for a new tattoo artist. |
Created: February 25, 2026 07:04 PM
