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SUN & SERENITY - ESTABLISHMENTSi �) �/✓t � ��2�G,1 r h ���UL U///I C� f'j✓�, Lniversal one, www.myuniversalop.com phone: 1-800-756-4676 UNV16162 MADE IN USA i Permit # TA -17-1 Date of Print 1/1212017 Permit Issued 1/1/2017 Permit Expires 12/31/2017 Permit Fee $140.00 Late Fee $0.00 Notes: This permit or license is granted in conformity with the statues and ordinances relating thereto, and expires on 12/31/2017 , unless sooner revoked or suspended. City of Salem, Massachusetts Board of Health 120 Washington Street, 4th Floor, Salem, MA 01970 PablicHeatth Re.en,. P.Omo,e Pealeel Tel. (9.78) 741-1800 Fax. (978) 745-0343 Larry Ramdin, MPH, RENS, CHO health@salem.com Health Agent TANNING FACILITY PERMIT License For Tanning Granted To: Sun & Serentiy / Dawn & James Carter Address: 58 Urban Street Lynn MA 01904 Location of Establishment: 540 LORING AVENUE Restrictions: CITY OF SALEM, MASSACHUSET y* BOARD OF HEALTH 120 WASHINGTON STREET, 4"" FY.C,7d�R ��j`1.01� ePubliCI%alth TEL. (978) 741-1800 FAX (978) 745-0343 rokC KIMBERL,EY DRISCOLL lramdin@salem.comOF N G\ \,0P RRY RAbDIN, RS/RFI IS, CI 10, CP -FS MAYOR gOP II:AvniAGVN'I TANNING FACILITY PERMIT APPLICATION Business Name: Cjk ��l(�li fid Phone #1 7f? WO-ff U'67 BUS. Address: -:)7u L,00( 4 64 VM Olam Salem MA. 01970 7 Owner(s) Na / Phone # Owner's Address: Gtr -61'4,4 1� 1A11nA , /yq. D/ 9d V FEE: $140.00 (MAKE CHECK PAYABLE TO — CITY OF SALEM) List -the manufacturer, model number, model year, serial number (if available) and type of each ultraviolet lamp or tanning device located within the facility. (If additional space is needed, please use the back of this application.) Mass. Electrical Code Article 90-6: Factory installed internal wiring or construction of equipment must be listed by a qualified electrical testing laboratory (U.L., E.T.L, or equivalent). This application must be accompanied by a check the following information: *name, business address of the tanning device supplier *name, business address of the tanning device installer *date of installation for each tanning device *name of service agent / ' /If of consent form used for patrons under the age of 18 (105 CMR 123.003 D) LG'� *copy of the operating and safety procedures to be followed in the operation of the facility and tanning devices I have re a co of 105 CMR 123.000: Tanning Facilities I here state a h e read and understood the requirements of these regulations. Si�nature of Applicant Date For Board of Health use only - Santanappll Ldoc updated 523/11 Check date: Check p: 1-2/ 7/161'7 y/, Heather, Here is the information you requested I submit. The tanning bed list you have on file everthing is the same except we no longer have the Sunvitale & Solart units They have been replaced by the following: s 11 e� ,�- Cungate 50/4 2007 serial #g50-00352 Manufacturer Dr. Muller V.2 .2t'll (\ Icon 46/4 2007 serial#46/4-0058 Manufacturer Dr. Muller Please let me know if you need any further information on my end. Thanks so much Dawn Carter 978-740-8867 or 781-888-2447 (cell) .Sec✓�� Sys Mire, Tanning Salon Release Sun & Serenity, LLC 540 Loring Avenue Salem, MA 01970 978-740-8867 www.sunandserenity.com Customer's Name: Address: City: Sate: Zip Code: Phone Number: Email Address: Date of Birth: Please check the box for your skin type: JEJ Light Medium Dark Have you ever used a tanning salon before? _ Yes _ No If ves, where? How did you hear about our Tanning Salon? Please check the box for your skin type when tanning? -- Always Burn, 11 Usually Burn, Sometimes Burn, Never Burn, Never Tan Sometimes Tan Always Tan Always Tan How long has it been since you have had a tan? Do you wear contact lenses? _ Yes _ No Have you ever had a severe sunburn? _ Yes _ No If yes, when did you last have a severe sunburn? Have you ever been advised by a physician to stay out of the sun? _ If yes, why were you advised by your doctor to stay out of the sun? Yes No PLEASE ADHERE TO THE FOLLOWING GUIDELINES WHILE USING OUR TANNING FACILITY: Please avoid overexposure while using our tanning beds. Similar to natural sunlight, overexposure can cause eye and skin injury and create allergic reactions. Repeated overexposure can cause premature aging and has also been known to cause skin cancer. Always wear protective eyewear while using our tanning beds. Failure to wear protective goggles may result in severe burning or injury to your eyes. For the best results it is highly recommended that you use an indoor tanning lotion. Please always inform a tanning salon team member if you are taking any medications that create sun sensitivity. You should consult a doctor before tanning if you are taking any medications that may cause an extra sensitivity to the sun or have a history of skin problems and are very sensitive to sun light. I fully understand that and have been made aware that I should only tan once in a twenty-four hour period. I hereby verify with my signature found below that I am 18 years old or older as required by state law. If you are pregnant or if there is a chance that you may be pregnant then you should not be using a tanning salon. We intend to keep you well informed about the tanning process by informing you how to operate the equipment as well as how to tan in a responsible manner. Our tanning technicians will inform you of proper tanning procedures in the tanning room. If you have any questions or have any concerns please address them at this time. It is always our goal to help you have the absolute best tanning experience possible in a responsible way. I hereby acknowledge that I have been given instructions on the proper use of the tanning equipment and I will use the tanning salon at my own risk. I release the tanning salon owners, operators and tanning bed manufactures from any and all damages that may result due to my use of the tanning beds and the tanning salon. Signature: Tanning Bed # EntryTime Exit Time {Tanning Package Total Amount. Due TanningTedimcianInitials Date:��, Q Permit # TA -16-1 Date of Print 1/12/2016 Permit Issued 1/1/2016 Permit Expires 12/31/2016 Permit Fee $140.00 Late Fee $0.00 Por Kimberley Driscoll Mayor City of Salem, Massachusetts Board of Health 120 Washington Street, 4th Floor, Salem, MA 01970 Tel. (978) 741-1800 Fax. (978) 745-0343 Iramdin@salem.com TANNING FACILITY PERMIT License For : Tanning Granted To: Sun & Serentiy / Dawn & James Carter Address: 58 Urban Street Lynn MA 01904 Location of Establishment: 540 LORING AVENUE Restrictions: Notes: 10 1PubHc ][iea Ith Pr P . P Larry Ramdin, MPH, REHS, CHO Health Agent This permit or license is granted in conformity with the statues and ordinances relating thereto, and expires on 12/31/2016, unless sooner revoked or suspended. Health Agent 10NIBERL.L:Y DRISCOLL NIAYOR Business Name: Bus. Address: CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4"' FLOOR TEL (978) 741-1800 FAX (978) 745-0343 lramdin(a)salem.com PublicHea ith Prevent Vramote. Protect. LARRY RANIDIN, RS/REHS, CFO, CP -FS HEAlATI AGENT TANNING FACILITY PERMIT APPLICATION � S w' �-5y0 LDo'll q 14✓e, Phone # Owner(s) Name: 1601!,0'0 Iold't `l alOV-S II C�tf�� i Phone # Owner's Address: �k U (bCt-A FEE: $140.00 (MAKE CHECK PAYABLE TO — CITY OF SALEM) List the manufacturer, model number, model year, serial number (if available) and type of each ultraviolet lamp or tanning device located within the facility. (If additional space is needed, please use the back of this application.) Mass. Electrical Code Article 90-6: Factory installed internal wiring or construction of equipment must be listed by a qualified electrical testing laboratory (LI.L., E.T.L, or equivalent). This application must be accompanied by a check the following information: *name, business address of the tanning device supplier *name, business address of the tanning device installer *date of installation for each tanning device *name of service agent *copy of consent form used for patrons under the age of 18 (105 CMR 123.003 D) *copy of the operating and safety procedures to be followed in the operation of the facility and tanning devices I have received a copy of 105 CMR 123.000: Tanning Facilities I hereby stat I have gad and understood the requirements of these regulations. ignature of Applicant Date For Board of Health use only Suntanapplll.doc updated5/23/11 Check date: , Check #: 9 Permit # TA -15-1 Date of Print 3/9/2015 Permit Issued 319/2015 Permit Expires 12/31/2015 Permit Fee $140.00 Late Fee $0.00 t Kimberley Driscoll Mayor City of Salem, Massachusetts Board of Health 120 Washington Street, 4th Floor, Salem, MA 01970 Tel. (978) 741-1800 Fax. (978) 745-0343 Iramdin@salem.com TANNING FACILITY PERMIT License For: Tanning Granted To: Sun & Serentiy / Dawn & James Carter Address: 58 Urban Street Lynn MA 01904 Location of Establishment: 540 LORING AVENUE Restrictions: Notes: 10 Public Health P P e.P Larry Ramdin, MPH, REHS, CHO Health Agent This permit or license is granted in conformity with the statues and ordinances relating thereto, and expires on 12/31/2015, unless sooner revoked or suspended. Health Agent CITY OF SALEM, MASSACHUSETTS `. BOARD OF HEALTH - -- -120 WASHINGTON STREET, 4TH FLOOR - - _ Prasea. h¢man. hcrc.. TEL. (978) 741-1800 FAX (978) 745-0343 lramdin&salem.com KIMIIERLEY DRISCOLL - LARRY RAMDIN, RS/REHS, CHO, CP-FS HEALTH AGENT TANNING FACILITY PERMIT APPLICATION Business Name: S Sut1 Md �'Ygcen 1+(/ Phone # q78.-7y0<$�G 7 Bus. Address:. 51-ID Lor i An j - QV Salem, MA. 01970 Owner(s) Name: Q u1(1 4 SCtn s G'fe.r Phone # 7e/-EfP-JW7 Owner's Address: 5J Llrba.,o Zy" SIC( 6)q©y FEE: $140.00 (MAKE CHECK PAYABLE TO — CITY OF SALEM) List the manufacturer, model number, model year, serial number (if available) and type of each ultraviolet lamp or tanning device located within the facility. (If additional space is heeded, please use the back of this application.) Mass. Electrical Code Article 90-6: Factory installed internal wiring or construction of equipment must be listed by a qualified electrical testing laboratory (U.L., E.T.L, or equivalent). This application must be accompanied by a check the following information: *name, business address of the tanning device supplier *name, business address of the tanning device installer - *date of installation for each. tanning device- *name of service agent *copy of consent form used for patrons under the age of 18 (105 CMR 123.003 D) *copy of the operating and safety procedures tobefollowed in the operation of the facility and - tanningdevices I have received a copy of 105 CMR 123.000: Tanning Facilities I hereby state that I have read and understood the requirements of these regulations. ' Signature of Applicant - - Date For Board of Health use only - - Suntanappll l.doc updated 5/23/11 Check date: ..Check N: 01 KIMBERLEY DRISCOLL MAYOR CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON S'rREET, 4"" FLOOR TEL. (978) 741-1800 FAX (978) 745-0343 lratudinnasalem.com O PablicHeaIth LARRY RANIDIN, RS/REI-IS, CHO, CP-] 'S HEAL, n-1 AGENT TANNING FACILITY PERMIT APPLICATION Business Name: SDIPC-`vci? Phone # j1 0_7W4 4 Bus. Address: scl O COL1 r.1c:� AVL- Salem, MA. 01970 �A rn Zv�r' �- ".6 Owner(s) Name: n, u � -W-1 Phone # 0\_78' Owner's Address: �c�nan iLoc-� Q� - yn �W� o\Ckoy FEE: $140.00 (MAKE CHECK PAYABLE TO — CITY OF SALEM) List the manufacturer, model number, model year, serial number (if available) and type of each ultraviolet lamp or tanning device located within the facility. (If additional space is needed, please use the back of this application.) Mass. Electrical Code Article 90-6: Factory installed internal wiring or construction of equipment must be listed by a qualified electrical testing laboratory (U.L., E.T.L, or equivalent). This application must be accompanied by a check the following information: *name, business address of the tanning device supplier *name, business address of the tanning device installer *date of installation for each tanning device *name of service agent *copy of consent form used for patrons under the age of 18 (105 CMR 123.003 D) *copy of the operating and safety procedures to be followed in the operation of the facility and tanning devices I have received a copy of 105 CMR 123.000: Tanning Facilities I hereby state that I have read and understood the requirements of these regulations. 12 -Al ) Signature of ApplicantDate f L 1 For Board of Health use only Suntanappl I l.doc updated 5/23/11 Check date: Check N: 3� I Ia�3)�►� V di o wAg�C' SOLAR ECLIPSE TANNING SALON EQUIPMENT LIST 540 LORING AVENUE SALEM, MA 01970 (978)740-8867 BED # I SUN VITALE ROOM MANUFACTURER: SUN VITALE MODEL: SUN VITALE 5000 SERIAL NUMBER: 1047 MODEL YEAR: 2001 SUPPLIER: FUTURE INDUSTRIES INSTALLER: FUTURE INDUSTRIES DATE OF INSTALLATION: 10/11/2001 SERVICE AGENT: DEREK HENTCHEL BED # 2 JETPOWER MANUFACTURER: ULTRA SUN MODEL: JETPOWER 1700 SERIAL NUMBER: MODEL YEAR: 2001 SUPPLIER: FUTURE INDUSTRIES INSTALLER: FUTURE INDUSTRIES DATE OF INSTALLATION: 10/11/2001 SERVICE AGENT: DEREK HENTCHEL BED # 3 MANUFACTURER: CREATIVE MARKETING MODEL: VHR 55 LAMP STAND UP SERIAL NUMBER: MODEL YEAR: 2001 SUPPLIER: CREATIVE MARKETING INSTALLER: CREATIVE MARKETING DATE OF INSTALLATION: 10/10/2001 SERVICE AGENT: DEREK HENTCHEL BED # 4 SONNENBRAUNNE MANUFACTURER: SONNENBRAUNNE MODEL: SONNENBRAUNNE 30/0 SERIAL NUMBER: 560432 MODEL YEAR: 2002 SUPPLIER: FUTURE INDUSTRIES INSTALLER: FUTURE INDUSTRIES DATE OF INSTALLATION: 10/11/2005 SERVICE AGENT: FUTURE INDUSTRIES BED # 5 ULTRA SUN MAGNUM ROOM MANUFACTURER: ULTRA SUN MODEL: ULTRA SUN MAGNUM SERIAL NUMBER: MODEL YEAR: 2001 SUPPLIER: FUTURE INDUSTRIES INSTALLER: FUTURE INDUSTRIES DATE OF INSTALLATION: 10/11/2001 SERVICE AGENT: DEREK HENTCHEL BED # 6 BOMBAY ROOM MANUFACTURER: AUVL MODEL: ELIXIR 40/3 SERIAL NUMBER: MODEL YEAR: 2004 SUPPLIER: FUTURE INDUSTRIES INSTALLER: FUTURE INDUSTRIES DATE OF INSTALLATION: 04/2004 SERVICE AGENT: DEREK HENTCHEL BED #7 WINE CELLAR ROOM MANUFACTURER: AUVL SERIAL NUMBER: MODEL YEAR: ELIXIR 2004 SUPPLIER: FUTURE INDUSTRIES INSTALLER: FUTURE INDUSTRIES DATE OF INSTALLATION: 04/2004 SERVICE AGENT: DEREK HENTCHEL BED# 8 SOLART ROOM MANUFACTURER: A/C/N MODEL: SOLART 55/5 MODEL YEAR: 2001 SUPPLIER: FUTURE INDUSTRIES INSTALLER: FUTURE INDUSTRIES DATE OF INSTALLATION: 02/02 SERVICE AGENT: DEREK HENTCHEL BED#9 MYSTIC TAN BOOTH MANUFACTURER: MYSTIC TAN CO. MODEL: MYSTIC TAN BOOTH SERIAL NUMBER: 2002302 SUPPLIER: MYSTIC TAN CO. INSTALLER: RUSH WAGHORNE DATE OF INSTALLATION: 08/02 SERVICE AGENT: RUSH WAGHORNE BED#10 LEG TANNER MANUFACTURER:ULTRASUN _ MODEL: LEGACY SERIAL NUMBER: 1423 SUPPLIER: FUTURE INDUSTRIES INSTALLER: FUTURE INDUSTRIES DATE OF INSTALLATION: 08/03 SERVICE AGENT: FUTURE INDUSTRIES CalTan Airbrush Gun & Compressor ALL EQUIPMENT PURCHASED FROM: FUTURE INDUSTRIES OF AMERICA 626 SURF AVE STRATFORD, CT 06489 800-346-3136 SOLAR ECLIPSE TANNING SALON RELEASE FORM Name: Home Phone: Address: Cell Phone: City, State, Zip: Email Address: Date of Birth: Skin Type: Light Med Dark Have You Ever Tanned Indoors Before? Yes No Where? How Did You Hear About Solar Eclipse? What is your Preferred Method of Hearing From Us? TEXT EMAIL ' PHONE How long has it been since you've had a tan? Do you tan easily? Yes No Do you have a tendency to burn? Yes No Do you have any known allergies to sunlight? ` Yes No Do you wear contacts? Yes No Have you ever had a severe sunburn? Yes No If so, how long ago? Have you ever been advised by a Doctor to stay out of the sun? If so, why? Are you taking any medications which are photosensitive? Do you have, or have you had during the past 3 months, any skin emption or communicable skin disease? Are You Pregnant? . P Always Bum, Never Tan Usually Bum, Sometimes Tan Sometimes Bum, Always Tan Never Bum, Always Tan IT IS OUR INTENTION TO KEEP YOU WELL INFORMED ABOUT TANNING. THIS INCLUDES INFORMING YOU ON HOW TO OPERATE THE EQUIPMENT AS WELL AS HOW TO TAN RESPONSIBLY. THE PROPER PROCEDURE TO FOLLOW IN THE TANNING ROOM WILL BE CLEARLY EXPLAINED TO YOU BY THE TANNING TECHNICIAN. PLEASE FEEL FREE TO ASK ANY QUESTIONS OR TO VOICE ANY CONCERNS THAT YOU MAY HAVE AT THIS TIME. OUR GOAL IS TO HELP YOU ACHIEVE THE BEST POSSIBLE TAN, RESPONSIBLY. PLEASE ADHERE TO THE FOLLOWING GUIDELINES WHEN TANNING: I. AVOID OVEREXPOSURE. AS WITH NATURAL SUNLIGHT, OVEREXPOSURE CAN CAUSE EYE AND SKIN INJURY AND ALLERGIC REACTIONS. REPEATED OVER EXPOSURE HAS BEEN KNOWN TO CAUSE PREMATURE AGING AND SKIN CANCER. 2. PLEASE INFORM US IF YOU ARE TAKING ANY SUN SENSITIVE MEDICATIONS. SOME MEDICATIONS OR COSMETICS MAY INCREASE YOUR SENSITIVITY TO UV RAYS. PLEASE CONSULT A PHYSICIAN BEFORE TANNING IF YOU ARE TAKING ANY SUCH MEDICATIONS OR HAVE A HISTORY OF SKIN PROBLEMS OR BELIEVE YOURSELF TO BE ESPECIALLY SENSATIVE TO SUNLIGHT. 3. WEAR PROTECTIVE EYEWEAR. FAILURE TO WEAR GOGGLES MAY RESULT IN SEVERE BURNS OR INJURY TO THE EYES. 4. 1 UNDERSTAND THAT IT IS THAT I USE AN INDOOR TANNING LOTION FOR MORE POSITIVE RESULTS. 5. MINOR CONSENT. I VERIFY WITH MY SIGNATURE THAT t AM 18 YEARS OF AGE OR OLDER AS REQUIRED BY LAW, IF 17 OR UNDER, A PARENTAL OR GUARDIAN SIGNATURE MUST ACCOMPANY THIS FORM. ANY INDIVIDUAL UNDER THE AGE OF 14 MUST HAVE A PARENT OR GUARDIAN PRESENT WHILE TANNING. 6. 1 UNDERSTAND AND HAVE BEEN MADE AWARE UNDERSTATE LAW, I AM ONLY PERMITTED TO TAN ONCE IN A 24 HR PERIOD. I HAVE BEEN GIVEN INSTRUCTIONS FOR THE PROPER USE OF THE EQUIPMENT AND I WILL USE IT AT MY OWN RISK. I HEREBY RELEASE THE OWNERS, OPERATORS, AND MANUFACTURERS FROM ANY'DAMAGES THAT I MIGHT INCUR DUE TO THE USE OF THESE TANNING UNITS AND FACILITIES. MEMBER SIGNATURE PARENTAL CONSENT DATE DO NOT WRITE BELOW THIS LINE. TO BE FILLED OUT BY THE TANNING TECHNICIAN. ' 11 TAN BED I TIME I PACKAGE I AMOUNT PAID STAFF INITIALS SOLAR ECLIPSE OPERATING PROCEDURES 1. CHECK IN TANNING GUEST 2. REVIEW THEIR INFORMATION, CHECKING THEIR AGE, LAST VISIT AND TANNING TIME 3. CHECK THEIR TANNING PACKAGE 4. DISCUSS WHICH BED THEY WOULD LIKE TO USE TODAY 5. RECOMMEND A TAN TIME TO THE GUEST 6. ESCOURT THE TANNING GUEST TO THEIR ROOM AND ENSURE THAT THE CUSTOMER KNOWS HOW TO OPERATE EVERYTHING IN THE ROOM. 7. COMPUTER AUTOMATICALLY WILL SET THE TIMER FOR THE DISSCUSSED TIME. Inspection of S+f w Owner -D #1Q-3 "t CAMI-`i &*,- Type of Inspection iii- 00 � 1� ( ' ) Remarks and Violations are listed below: Qtc'1NSE�•ifaeb ncvj i �L�Wvasl�t OF 'i *<-. SC, W Date Time )Q I_)54n Address L,:1Zy J l�j A4t-- Tel. No. Inspector`J lhC'LL t�i�fa ni'.a�� 41)LI'I-Al ?) '7l 657 r Gig %1ta Qohr,� a+2� Ott ca cwl �� T tie, FR ,L& c)e Gyuv%G\C" �L i o�h`n, V ►own-r� o�+S G7�,'-D Cs,;4'8"1 S� oc� t f ► S .4ZP►t tC t�� t o O �' ��ti tem Report Received by: Inspection of Sj W 'h' rr Name Owner"T")nU44 (.4Cat1.1 Type of Inspection Th TJ►J ` c� 1 * 1 Remarks and Violations are listed below: Qt -1 aSPE.I�tl<1 r4cT-O r Date '3 ,�'ls Time lo'�S Ant Address c',�yy J -a Qt eJ V1 nth" Tel. No. L'1 7? -7,441 - Inspector hgbi1 I I 'ftrrC 0F'nA(-, SoLR(LS) 11k-® WA) 9L"f. 'no1 w 'Tbv-Q. OT R,om(tgoY! Rico SIJ S 87F i v3 114 7, �VMZ; Zu v v,, k t ci a c�a 1 I .�a� (�,t t� S J . Zzrh qL- Ov, L'Al."NCA" 01 Lk, 01-1 V 10I..CN7\ o, S CATe,- a G —1 1 - 7.9• )� )im,v'c of � G�s1 ups Report Received by: Inspection of S�Zgqrz- LGZ% PS><. LLi— Owner Type of Inspection :�M11' 0 IC41 ( ' I Remarks and Violations are listed below: Date ' ��c�'-%y'�L�,Timee 2-1� Pdb, Address �('t 7°-' —ADxb/CI 4V1f- _ Tel. No. Inspector tsyi-Y',Li�9�Jrn L� lrytA (t�i 1L�' Y15 A 9—I✓Sut-T OF A U411dII4L-4 , Int 0446IM-SW Aa jf4Se 6-MgrA Gt 7'11'1:1 `4 VAI fA bt I -A I S C(&7,-SG)(&7,-SG)1,44]� /V(J (--> t� C [' r^ t:) Lt,40" I,, Ps4j-tzP 514"41) !�10 Slko Ili lj)`fhucj 1 � I (A,A Limo A 9-f,-0 Aa ' r, cif' cILACIZ'S. I S((aa yJiRwT)-V Report Received by: ► o t� C i �� �l) to o -"'i L/J Vr� Aa ' r, cif' cILACIZ'S. I S((aa yJiRwT)-V Report Received by: Inspection of Name— &,C, tj ame &,C,tl pSc. Date ''a'S Time Z'.Vj6Pdh Address -Xb 'IbZ ( G,Ay,"r—' ppp Type of Inspection `irlctPt 146' InspectorD (s`�1.Y.✓ ►RONm i -- t„Ca(,0IG1 (' I Remarks and Violations are listed below: is /asJ� 0% Gii�ol�aY. UtJ�1cr11tiJL-S(P AeJ /n1SG� l�iC�loe rU11 I'r�>G)4ya Fnc,��LI W A t CC14WycryACA(--) )IA(-, Fc)c.VQ"�N(�, r4o1' ' I nl D4,1, La c) L-- '10 tAClGeP )aoQF -nl )) RIso ;' OC- T'yPvM ✓QMt,- R"a.f4) 41 ),4 W.; J'cT Po tA'p. gQC1 • NOS CM C.1L a )vim TD 'I q-, r LQ'Nti FL-4i—,)C, 24A)II is 0.72f- P" --W "I Tali )�j ^Nb W)c;4 L C, L"7— , Z,- .� A lA(Zk Q ).A �)) AS'PU IL4ya'l') TZ) - SAvj` ?tkmT Frf- C) wl qO - to TA:?6 )S**\z car Report Received by: Inspection of SOL")- U--�V\. P a Owner Type of Inspection ( * ) Remarks and Violations are listed below: W &C, `tS�il7 Vyom I- ViL' A), 5,3uD, L Date I'A—' 19 Time 2> J Address Tel. No. Inspector V q4'47- or P 1) ye0 rt V\i,! w ffA e-4-0 gfh(,Y- (;araV4 D fYt4b W4'1 j� u�-'Trtwass Report Received Inspection of ��.(� \I g �� ' Date • /'r -i) C' r Time Name Address Owner II Type of Inspection ( * 1 Remarks and Violations are listed below: Tel. No. Inspector vS',f- arF 5144-Mye u,;�a ,-t Rmh_ (amymr-) a Report Received W KIMBERLEY DRISCOLL MAYOR LARRY RAMO N, RS/RBHS, CHO, CP -FS HEALTH AGENT DATE: ) -2g -) j ( i11 Iii S L Ni M1SSA(1Irni i'IS B0 kRI)(A t11 AtaH 120 WASHINGTON S 7 EE 1, 4'" FLOOR T1:1- (978)'.41 1800 F Ax (978) 745 0343 1.RAN1D IN @SAl.HM.COM TANNING FACILITY INSPECTION FORM ESTABLISHMENT: SOLn0. CLIP TIME IN: 2-'3o TIME OUT: ''- ADDRESS: S �o Aait PHONE: 00t' -)Vo FSK 6 PERSON IN CHARGE: NUMBER OF DEVICE(S): BED(S): 7 BOOTH(S): MODEL NAME(S): BED(S): MODEL NAME(S): BOOTH(S): REGULATIONS 105 CMR 123.000 DEPARTMENT OF PUBLIC HEALTH TANNING FACILITIES Regulation Compliance YES NO Number Title and Description 123.003 Physical Plant: Warning sign: Posted within three (3) feet of each tanning (A)(1)(a &b) ✓ device. Printed in white on a red background 123.003 Physical Plant: Tanning device manufactured and certified to comply with (A)(2)(a) 21 CFR 1040.20 123.003 Physical Plant: Timers: Maximum timer interval shall not exceed the (A)(2)(b) manufacturer's maximum recommended exposure time. No timer interval shall have an error greater than plus or minus 10% the maximum time interval for the device. 123.003 Physical Plant: Physical barrier in device to protect customers from injury (A)(2)(d & e) V induced by touching or breaking the lamps. In booths, floor markings indicating the proper exposure distance between lamps and customer's skin. 123.003 Physical Plant: Lamps replaced with a type intended for use in that tanning (A)(2)(f) ✓ device specified on the product label or that are equivalent under the U.S.F.D.A regulations. 123.003 Physical Plant: Licensee maintains records of recommended exposure time (A)(2)(g) ✓ established by the manufacturer of the tanning device. Operator follows and limits the recommended exposure times established by such records. 123.003 Physical Plant: Temperature: The interior temperature of the tanning device A (2)(h 1/ shall not exceed 100°F. 123.003 Protective Eyewear: Protective eyewear complies with 21 CFR 1040(c)(4) (B)(1, 2 & 3) v and made available to customers before each tanning session. Protective eyewear, other than one-time use, shall be properly sanitized with an EPA KIMBERI,EY DRISCOLL MAYOR LARRY RAMO N, RVRLHS, CHO, CP—FS HEALTH A(iRkT DATE: 1- 21-) J C 11y Ok SAI I M M SSA(I ILNI.']TS Bo mmOw I11:AIAl1 120 WASHINGTON STREET, 4"' FLOOR TIA'. (978) 741-1800 FAX (978) 745-0343 LRAMDIN&SALFM.COM registered sanitizer manufactured for use with protective eyewear. TANNING FACILITY INSPECTION FORM ESTABLISHMENT: So L4ZA, P fit, l '? Je, REGULATIONS 105 CMR 123.000 DEPARTMENT OF PUBLIC HEALTH TANNING FACILITIES Regulation Compliance Number Title and Description YES I NO I 123.003 Operators: Sufficiently trained and knowledgeable operator must be present at (C)(1, 2 & 3) the tanning facility at all times during operating hours. A list of facility operators is maintained and available at the facility. 123.003 Records: Customers are given a written warning statement and sign a written (13)(1) statement acknowledging that he/she has read and understood the warning statement each time a customer uses (one time tanning), executes or renews a contract. 123.003 Records: No person 14 — 17 yrs. of age shall use a tanning device without (D)(2) written consent of a parent or legal guardian that they have read and understood the warning statement. The operator must sign the consent form as a witness to the signing by the parent or legal guardian. 123.003 Records: No person under 14 yrs. of age shall use a tanning device unless (D)(3) V accompanied by a parent or legal guardian. Consent forms shall be signed indicating the warning statement has been read and understood. 123.003 Records: Records shall be kept by the operator of each customer's total (D)(4 & 5) number of tanning visits and tanning times. Records shall be maintained for at least 12 months from the customer's last tanning session. Records must be l/ maintained at the tanning facility and made available for review by inspectors and tanning facility customers upon request. 123.003 Injury Reports: Written reports of tanning injuries or complaint of injury shall be (E)(1) C/ forwarded by the facility to the City of Newton's Commissioner of Health within five 5 working days of its occurrence. 123.003 Sanitation: Provide access to toilet and hand washing facility. (F)(1) Clean facility every 24 hrs. Provide soap, paper towels and trash receptacle 123.003 Sanitation: Provide safe and sanitary drinking water at all times. F 2 1� 123.003 LIZ Sanitation: Provide customers paper or cloth towels. Cloth towels are washed (F)(3) and sanitized after each use. 123.003 Sanitation: All tanning surfaces customers have contact with are disinfected HIW ERLEY DRISCOLL MAYOR LARRY RAMO N, RS/REHS, CHO, CP -PS HEALTH AGENT Cllr OF SAL K1MA-,gACI R1SFTFS BO AM) OF 114. AL 11 120 WAIINGTON STRP.b7T 4-1 FLOOR Tei. (978) 741-1800 FAx (978) 745-0343 LRAMrHN(a)CAI F?M COM F 4 '✓ I after each customer's use using an EPA registered disinfectant. 123.003 Title and Description Sanitation: Hot water in showers (if provided) shall be 110 - 130°F. Showers F 6 Issuance of License: Each tanning facility's license must be displayed in a (D) shall be cleaned and disinfected at least every 24 hours. 123.003 conspicuous place in the facility. 123.008 Sanitation: Interior facility shall be maintained in good repair and in safe, (F)(7 & 8) Report of Changes: Licensee shall notify the City of Newton's Commissioner clean, sanitary condition which is free from accumulation of dirt and rubbish. All of Health BEFORE making any changes (does not apply to changes involving equipment & fixtures shall be installed in accordance with plumbing, gas fitting replacement of lamp bulbs). 123.009 and electrical wiring standards. TANNING FACILITY INSPECTION FORM DATE: )-2¢)5 ESTABLISHMENT: _ 45GUsv, REGULATIONS 105 CMR 123.000 DEPARTMENT OF PUBLIC HEALTH TANNING FACILITIES Regulation Compliance I Number Title and Description 123.007 ✓ Issuance of License: Each tanning facility's license must be displayed in a (D) conspicuous place in the facility. 123.008 Report of Changes: Licensee shall notify the City of Newton's Commissioner of Health BEFORE making any changes (does not apply to changes involving replacement of lamp bulbs). 123.009 Non -Transferability of License: No license shall be transferable from one person to another or from one tanning facility to another. Additional Comments: SF—wmr RINIHERI,FY DRISCOM, MAYOR LARRY RAMDIN, RS/RFHS, CHO, CP -FS HEALTH AGENT PASSED INSPECTION INSPECTOR'S SIGNA PERSON IN CHARGE: ( IIS Ot SALt N Df 1CSA(lltl �. TPS BOARD (W i1iA.t.iiI 120 WSSI IINGI ON S1 R[.8T 41O FLOOR Tvi- (978) 741-1800 i'AX (978) 745-0343 1,RAMDIN@SALF.M.00M YES ❑ B NO 131 RE-INSPECTIONDATE: D WARNING SIGN DANGER - ULTRAVIOLET RADIATION 1. Follow instructions. 2. Avoid too frequent or lengthy exposure. As with natural sunlight, exposure to a sunlamp may cause eye and skin injury and allergic reaction. Repeated exposure may cause chronic damage characterized by wrinkling, dryness, fragility, bruising of the skin and skin cancer. 3. Wear protective eyewear. FAILURE TO USE PROTECTIVE EYEWEAR MAY RESULT IN SEVERE BURNS OR LONG TERM INJURY TO THE EYES. 4. Ultraviolet radiation from sunlamps aggravates the effects of sun. Do not sunbathe before or after exposure to ultraviolet radiation. 5. Abnormal or increased skin sensitivity or burning may be caused by certain foods, cosmetics or medications, including but not limited to, tranquilizers, diuretics, antibiotics, high blood pressure medication, birth control pills and skin creams. KIMBERLEY DRISCOLL MAYOR LARRY RAMO N, RS(REHS, CHO, C'P-FS HEALTH AOFNT CIIYOFSALEM, MLSSAIRJS1:Y1'S BO ARD(ri ITHAI:J II 120 WASI TING'I ON STREET, 41" FLOOR (978) 741-1800 f�AX (978) 745-0343 1.RAMUIN(a)SAi EM COM Consult a physician before using a sunlamp if you are using medication, have a history of skin problems, or believe you are especially sensitive to sunlight. Pregnant women or women on birth control pills who use a tanning device may develop discolored skin. 6. IF YOU DO NOT TAN IN THE SUN YOU WILL NOT TAN FROM USE OF THIS DEVICE. Use of a tanning device does not provide a substantial protective base against the effects of the sun. Operators Each operator must be trained and sufficiently knowledgeable in the correct operation of tanning devices used at a facility. That knowledge shall include: a. The requirements of 105 CMR 123.000 and 21 CFR 1040.20 as amended from time to time. b. Proper use of U.S.F.D.A. recommended exposure schedule. c. Photosensitizing agents such as: Foods, cosmetics, and medications that may produce abnormal or increased skin sensitivity. d. Skin type determination. KIMBERLEY DRISCOLL MAYOR LARRY RAMDIN, RS(RLHS, CHO, CP -FS HEALTH AGENT C U Y OF SAL} NJ, nI NSSAI HUSFTJ S Boom(-)[ HI;;wIn1 120 WASHINGTON STREET, 4111 FLOOR TI;L. (978) 741-1800 FAX (978) 745-0343 LR.AMDINLSALF,M C'0M e. Recognition of injuries from overexposure to ultraviolet radiation. f. Manufacturer's procedures for the correct operation and maintenance of the tanning device. g. Use of protective eyewear. h. Emergency procedures in case of injury. i. Effects of ultraviolet radiation, acute and chronic exposure, biological effects and health risks. j. Electromagnetic spectrum with emphasis on the photobiology and physics within the 200 — 400 nanometer range. TANNING FACILITY INSPECTION FORM DATE: 1 ESTABLISHMENT: CAuata,-1aQ_l� ROOM NUMBER / NAME: 50L)Actn BOOTH: ❑ BED: MAXIMUM TIME ALLOWED AMOUNT OF TIME FOR THE DEVICE: INSPECTED ON 10 Minutes DEVICE: j(-7 Minutes TEMPERATURE: )02-Z inai OF SHUTOFF ) 5 TIME: )c7 d 2 Minutes COMPLIANCE: YES ❑ NO R COMPLIANCE: YES 2 NO ❑ ROOM NUMBER/ NAME: BOOTH: ❑ BED: CY MAXIMUM TIME ALLOWED AMOUNT OF TIME FOR THE DEVICE: INSPECTED ON '20 Minutes DEVICE: zd Minutes TEMPERATURE: )30.5 OF SHUT OFF ) 5 TIME: 20. OS Minutes n/ COMPLIANCE: YES L7 NO ❑ COMPLIANCE: YES R'NO ❑ ROOM NUMBER/ NAME:IY»GO\)r BOOTH: ❑ BED: MAXIMUM TIME ALLOWED AMOUNT OF TIME FOR THE DEVICE: INSPECTED ON ) 5 Minutes DEVICE: )5 Minutes TEMPERATURE: 76 OF SHUT OF �$:a TIME: Minutes 0 11 COMPLIANCE: YES CJ NO COMPLIANCE: YES EJutNO TANNING FACILITY INSPECTION FORM DATE: ESTABLISHMENT: ROOM NUMBER / NAME: R�6� BOOTH: ❑ BED: MAXIMUM TIME ALLOWED FOR THE DEVICE: AMOUNT OF TIME FOR THE DEVICE: DEVICE: Minutes INSPECTED ON j Z Minutes DEVICE: ) Z Minutes TEMPERATURE: 10&-.l »,ar-* OF SHUT OFF TIME: / 2:(30 Minutes COMPLIANCE: YES El NO n/ COMPLIANCE: YES El NO L7 ROOM NUMBER I NAME: S&I V) JC413�. BOOTH: ❑ BED: MAXIMUM TIME ALLOWED AMOUNT OF TIME FOR THE DEVICE: INSPECTED O g Minutes DEVICE: Minutes TEMPERATURE: OF SHUT OFF TIME: Minutes COMPLIANCE: YES 9' NO ❑ COMPLIANCE: YES 9NO ❑ ROOM NUMBER / NAME:,') -F-7- Pwi+ BOOTH: ❑ BED: MAXIMUM TIME ALLOWED AMOUNT OF TIME FOR THE DEVICE: INSPECTED ON Minutes DEVICE: lS Minutes TEMPERATURE: OF SHUT OFF TIME: %S Minutes COMPLIANCE: YES 2"�NO ❑ COMPLIANCE: YES El' NO ❑ TANNING FACILITY INSPECTION FORM DATE: ESTABLISHMENT: ROOM NUMBER / NAME: 1-� BOOTH: ❑ BED: MAXIMUM TIME ALLOWED AMOUNT OF TIME FOR THE DEVICE: INSPECTED ON 10 Minutes DEVICE: )0, Minutes TEMPERATURE: O. 5' OF SHUT OFF DEVICE: ) 2 TIME: )(:Yd L Minutes COMPLIANCE: YES NO ❑ COMPLIANCE: YES 9-� NO ❑ ROOM NUMBER / NAME: BOOTH: ❑ BED: MAXIMUM TIME ALLOWED MAXIMUM TIME ALLOWED AMOUNT OF TIME INSPECTED ON FOR THE DEVICE: INSPECTED ON TEMPERATURE: OF Minutes DEVICE: ) 2 Minutes TEMPERATURE: U J' OF SHUT OFF TIME: )Z'dS Minutes COMPLIANCE: YES �NO ❑ COMPLIANCE: YES LJ NO ❑ 551Gfw� ROOM NUMBER/ NAME: fbL) IPA -S BOOTH: BED: ❑ MAXIMUM TIME ALLOWED AMOUNT OF TIME FOR THE DEVICE: INSPECTED ON �O Minutes DEVICE: )O Minutes TEMPERATURE: OF SHUT OFp TIME: Id o3 Minutes COMPLIANCE: YES NO ❑ COMPLIANCE: YES V NO ❑ KIMBERLEY DRISCOLL MAYOR CITY OF SALEM, MASSACHUSET"T"S 'BOARD OF HEALTH 120 WASHINGTON STREET, 4T FLOOR - TEL. (978) 741-1800 FAX (978) 745-0343 lramdiniia salem.com IPl�9ir. PT.SE41P..iNif{I.. LARRY RAbiDIN, RS/REHS, CHO, CP -FS HEALTH AGENT TANNING FACILITY PERMIT APPLICATION Business Name: k )M &PJ �QceAl-+i / Phone # Jjjlq -067 Bus. Address: 541D LO r l fl y Q J2 Salem, MA. 01970 Owner(s) Name: 4 JctaltS (b,({--Pf- Phone # 7k(;kif jgg7 Owner's Address: 50 urba4 D LV ILA cL- FEE: $140.00 (MAKE CHECK PAYABLE.TO — CITY OF SALEM) List the manufacturer, model number, model year, serial number (if available) and type of each ultraviolet lamp or tanning device located within the facility. (If additional space is needed, please use the back of this application.) Mass. Electrical Code Article 90-6: Factory installed internal wiring or construction of equipment must be listed by a qualified electrical testing laboratory (II.L., E.T.L, or equivalent). This application must be accompanied by a check the following information *name, business address of the tanning device supplier *name, business address of the tanning device installer *date of installation for each tanning device *name of service agent *copy of consent form used for patrons under the age of 18 (105 CMR 123.003 D) *copy of the operating and safety procedures to be followed in the operation of the facility and tanning devices I have received a coj y of 105 CMR 123.000: Tanning Facilities I hereby state that I have read and understood the requirements of these regulations. Signature of Applicant Date For Board of Health use only Suntanappl l l.doc updated 5/13/11 Check date: Check 4: SOLAR ECLIPSE TANNING SALON RELEASE FORM Name: - Home Phone: - Address: Cell Phone: City, State, Zip: Email Address: Date of Birth: Skin Type: Light Med Dark Have You Ever Tanned Indoors Before? Yes No Where? How Did You Hear About Solar Eclipse? What is Your Preferred Method of Hearing From Us? TEXT EMAIL PHONE STAFF INITIALS How long has it been since you've had a tan? Have you ever been advised by a Doctor to stay out of the sun? Do you tan easily? Yes No If so, why? Do you have a tendency to burn? Yes No Are you taking any medications which are photosensitive? Do you have any known allergies to sunlight? Yes No Do you have, or have you had during the past 3 months, any skin Do you wear contacts? Yes - No eruption or communicable skin disease? - Have you ever had a severe sunburn? Yes No Are You Pregnant? If so, how long ago? Always Bum, Never Tad Usually Burn, Sometimes Tan Sometimes Burn, Always Tan Never Burn, Always Tan IT IS OUR INTENTION TO KEEP YOU WELL INFORMED ABOUT TANNING. THIS INCLUDES INFORMING YOU ON HOW TO OPERATE THE EQUIPMENT AS WELL AS HOW TO TAN RESPONSIBLY. THE PROPER PROCEDURE TO FOLLOW IN THE TANNING ROOM WILL BE CLEARLY EXPLAINED TO YOU BY THE TANNING TECHNICIAN. PLEASE FEEL FREE TO ASK ANY QUESTIONS OR TO VOICE ANY CONCERNS THAT YOU MAY HAVE AT THIS TIME. OUR GOAL IS TO HELP YOU ACHIEVE THE BEST POSSIBLE TAN, RESPONSIBLY. PLEASE ADHERE TO THE FOLLOWING GUIDELINES WHEN TANNING: 1. AVOID OVEREXPOSURE. AS WITH NATURAL SUNLIGHT, OVEREXPOSURE CAN CAUSE EYE AND SKIN INJURY AND ALLERGIC REACTIONS. REPEATED OVEREXPOSURE HAS BEEN KNOWN TO CAUSE PREMATURE AGING AND SKIN CANCER. 2. PLEASE INFORM US IF YOU ARE TAKING ANY SUN SENSITIVE MEDICATIONS. SOME MEDICATIONS OR COSMETICS MAY INCREASE YOUR SENSITIVITY TO UV RAYS. PLEASE CONSULT A PHYSICIAN BEFORE TANNING IF YOU ARE TAKING ANY SUCH MEDICATIONS OR HAVE A HISTORY OF SKIN PROBLEMS OR BELIEVE YOURSELF TO BE ESPECIALLY SENSATIVE TO SUNLIGHT. 3. WEAR PROTECTIVE EYEWEAR. FAILURE TO WEAR GOGGLES MAY RESULT IN SEVERE BURNS OR INJURY TO THE EYES. 4. I UNDERSTAND THAT IT IS RECOMMENDED THAT I USE AN INDOOR TANNING LOTION FOR MORE POSITIVE RESULTS. 5. MINOR CONSENT. I VERIFY WITH MY SIGNATURE THAT I AM 18 YEARS OF AGE OR OLDER AS REQUIRED BYLAW. IF 17 OR UNDER, A PARENTAL OR GUARDIAN SIGNATURE MUST ACCOMPANY THIS FORM. ANY INDIVIDUAL UNDER THE AGE OF 14 MUST HAVE A PARENT OR GUARDIAN PRESENT WHILE TANNING. 6. I UNDERSTAND AND HAVE BEEN MADE AWARE UNDER STATE LAW, I AM ONLY PERMITTED TO TAN ONCE IN A 24 HR PERIOD. --- I HAVE BEEN GIVEN INSTRUCTIONS FOR THE PROPER USE OF THE EQUIPMENT AND I WILL USE IT AT MY OWN RISK. I HEREBY RELEASE THE OWNERS, OPERATORS, AND MANUFACTURERS FROM ANY DAMAGES THAT I MIGHT INCUR DUE TO THE USE OF THESE TANNING UNITS AND FACILITIES. MEMBER SIGNATURE PARENTAL CONSENT DATE UVINVI wm IC nELO, INOLINE. TAN BED IV BE FILLED M113. TIME PACKAGE AMOUNT PAID STAFF INITIALS SOLAR ECLIPSE TANNING SALON _ EQUIPMENT LIST 540 LORING AVENUE SALEM, MA 01970 (978) 740-8867 BED # 1 SUN VITALE ROOM MANUFACTURER: SUN VITALE MODEL: SUN VITALE 5000 SERIAL NUMBER: 1047 MODEL YEAR: 2001 SUPPLIER: FUTURE INDUSTRIES INSTALLER: FUTURE INDUSTRIES DATE OF INSTALLATION: 10/11/2001 SERVICE AGENT: DEREK HENTCHEL BED #2 JETPOWER MANUFACTURER: ULTRA SUN MODEL: JETPOWER 1700 SERIAL NUMBER: MODEL YEAR: 2001 SUPPLIER: FUTURE INDUSTRIES INSTALLER: FUTURE INDUSTRIES DATE OF INSTALLATION: 10/11/2001 SERVICE AGENT.: DEREK HENTCHEL BED # 3 MANUFACTURER: CREATIVE MARKETING MODEL: VHR 55 LAMP STAND UP SERIAL NUMBER: MODEL YEAR: 2001 SUPPLIER: CREATIVE MARKETING INSTALLER: CREATIVE MARKETING DATE OF INSTALLATION: 10/10/2001 SERVICE AGENT: DEREK HENTCHEL BED # 4 SONNEN13RAUNNE MANUFACTURER:SONNENBRAUNNE MODEL: SONNENBRAUNNE 30/0 SERIAL NUMBER: 560432 MODEL YEAR: 2002 SUPPLIER: FUTURE INDUSTRIES INSTALLER: FUTURE INDUSTRIES DATE OF INSTALLATION: 10/11/2005 SERVICE AGENT: FUTURE INDUSTRIES ULTRA SUN MAGNUM ROOM MANUFACTURER: ULTRA SUN MODEL: ULTRA SUN MAGNUM SERIAL NUMBER: MODEL YEAR: 2001 SUPPLIER: FUTURE INDUSTRIES INSTALLER: FUTURE INDUSTRIES DATE OF INSTALLATION: 10/11/2001 SERVICE AGENT DEREK HENTCHEL BED #6 BOMBAYROOM MANUFACTURER: AUVL MODEL: ELIXIR 40/3 SERIAL NUMBER: MODEL YEAR: 2004 SUPPLIER: FUTURE INDUSTRIES INSTALLER: FUTURE INDUSTRIES DATE OF INSTALLATION: 04/2004 SERVICE AGENT: DEREK HENTCHEL BED #7 WINE CELLAR ROOM MANUFACTURER: AUVL SERIAL NUMBER: MODEL YEAR: ELIXIR 2004 SUPPLIER: FUTURE INDUSTRIES INSTALLER: FUTURE INDUSTRIES DATE OF INSTALLATION: 04/2004 SERVICE AGENT: DEREK HENTCHEL BED#8 SOLART ROOM MANUFACTURER: A/C/N MODEL: SOLART 55/5 MODEL YEAR: 2001 SUPPLIER: FUTURE INDUSTRIES INSTALLER: FUTURE INDUSTRIES DATE OF INSTALLATION: 02/02 SERVICE AGENT: DEREK HENTCHEL BED#9 MYSTIC TAN BOOTH MANUFACTURER: MYSTIC TAN CO. MODEL: MYSTIC TAN BOOTH SERIAL NUMBER: 2002302 SUPPLIER: MYSTIC TAN CO. INSTALLER: RUSH WAGHORNE DATE OF INSTALLATION: 08/02 SERVICE AGENT: RUSH WAGHORNE BED # 5 BED#10 LEG.TANNER MANUFACTURER:ULTRASUN MODEL: LEGACY SERIAL NUMBER: 1423 SUPPLIER: FUTURE INDUSTRIES INSTALLER: FUTURE INDUSTRIES DATE OF INSTALLATION: 08/03 SERVICE AGENT: FUTURE INDUSTRIES CalTan Airbrush Gun & Compressor ALL EQUIPMENT PURCHASED FROM: FUTURE INDUSTRIES OF AMERICA 626 SURF AVE STRATFORD, CT 06489 800-346-3136 Y SOLAR ECLIPSE OPERATING PROCEDURES 1. CHECK IN TANNING GUEST 2. REVIEW THEIR INFORMATION, CHECKING THEIR AGE, LAST VISIT AND TANNING TIME 3. CHECK THEIR TANNING PACKAGE 4. DISCUSS WHICH BED THEY WOULD LIKE TO USE TODAY ' . 5. RECOMMEND A TAN TIME TO THE GUEST 6. ESCOURT THE TANNING GUEST TO THEIR ROOM AND ENSURE THAT THE CUSTOMER KNOWS HOW TO OPERATE EVERYTHING IN THE ROOM. 7, COMPUTER AUTOMATICALLY WILL SET THE TIMER FOR THE DISSCUSSED TIME. L Permit # TA -15-1 Date of Print 1129/2015 Permit Issued 1/29/2015 Permit Expires 12/31/2015 Permit Fee $140.00 Late Fee $0.00 T'� n Granted To: City of Salem, Massachusetts Board of Health 120 Washington Street, 4th Floor, Salem, MA 01970 Tel. (978) 741-1800 Fax. (978) 745-0343 Iramdin@salem.com TANNING FACILITY PERMIT License For: Tanning Sun & Serentiy / Dawn & James Carter Address: 58 Urban Street Lynn MA 01904 Location of Establishment: 540 LORING AVENUE Restrictions: Notes: PublicHeatth Larry Ramdin RS/REHS, CHO, CP -FS Health Agent This permit or license is granted in conformity with the statues and ordinances relating thereto, and expires on 12/31/2015 , unless sooner revoked or suspended. Health Agent Permit # TA -15-1 Date of Print 1/29/2015 Permit Issued 1/29/2015 Permit Expires 12/31/2015 Permit Fee $140.00 Late Fee $0.00 0 Kimberley Driscoll Mayor Granted To: City of Salem, Massachusetts Board of Health 120 Washington Street, 4th Floor, Salem, MA 01970 Tel. (978) 741-1800 Fax. (978) 745-0343 Iramdin@salem.com TANNING FACILITY PERMIT License For: Tanning Sun & Serentiy / Dawn & James Carter Address: 58 Urban Street Lynn MA 01904 Location of Establishment: 540 LORING AVENUE Restrictions: Notes: PublicHealth Prcvevl. P.omole. Protect. Larry Ramdin RS/REHS, CHO, CP -FS Health Agent This permit or license is granted in conformity with the statues and ordinances relating thereto, and expires on 1213112015 , unless sooner revoked or suspended. e Health Agent