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I <br /> Body Art Inspection Report Date(MM/DD/YY) <br /> y County of San Joaquin County,Environmental Health Department Y51S3 1 <br /> + Permit Number <br /> < 1868 E.Hazelton Ave.,Stockton CA 95205 <br /> (209)468-3420 www.sioov.oro/ehd />a Zo <br /> Permit Type "1 <br /> 4G'/FORa <br /> Facility Name Address City Zip Code CT <br /> 11 � c'�+��no 5�ur11 a q 11 C¢�-j•�l I�.Ir. 7r�c� �I sv) <br /> Permit/Registrati n Holder Name Permit Exp.Date Total Time Inspection Type <br /> Jon 1144Y)A Qom'-e . <br /> 35. Plan Review ❑ 7 <br /> 36 Permits Obtained&Available* ❑ <br /> 37. Impoundment77 <br /> ❑ <br /> 38. Hearing Scheduled ❑ <br /> 39. Closure* ❑ <br /> Items marked vdth an asterisk*may also havespecific requirements for temporary events <br /> REG# .. PRACTITIONERIARTIST NAME::=`c, .x REG#. �' t PRACTITIONERIARTIS NAME <br /> S1S313 n Wluted <br /> Nor)*- c1r So nos. <br /> i S�'Gn' ' <br /> M11143'137 <br /> �3'1�t4 Q.l curc�DCj4r nuS Li3.88P <br /> X53 �1, rU, -1AU ct <br /> " OBSERVATIONS'%1NU`CORRECENE'ACTIONS <br /> 7 9 11 3 T -,w,- 6o*0m u 'a 1 S <br /> t G)y o ar i 'IA 01 i Lu <br /> " o 3 <br /> 11 I - (A t �► c w S ' s Sin <br /> Go. A%" � 01). -On;s fA 14 a A si '� <br /> cold k ; Vk A �� �r. <br /> wsin WA Lo tNw aS �����lladl r,�fS 1 <br /> �b q 1 9 Il�`311 1 313 — W3 l svu eA1� <br /> (AttuS I n 'f14/-' 1�e ert- <br /> c S Si � Ur W d <br /> A ,' c, o <br /> Corte;^�l fi s ulen� gun m�tet,+ <br /> Received by(Print): SQA Received by(Signature): Phone: <br /> Specialist(Print): Specialist(Signature): Phone: <br /> F-1This report is an Official Notice of Violation.Corrections must be completed in the time specified. <br /> A reinspection fee may be charged if violations noted on this report are not corrected by the reinspection date. Reinspection Date(on or about) <br /> Page)-of <br />