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t <br /> /o/�°''"' �o Body Art Inspection Report Date(MM/DD/YY) urs_ <br /> / County of San Joaquin County,Environmental Health Department Sn„nl_�qOu <br /> c Permit Number <br /> 1868 E.Hazelton Ave.,Stockton CA 95205 <br /> (209)468-3420 wywJ.sigoy.org/ehd t/Imo_ <br /> Permit Type —1 <br /> Facility Nameddress s�iy Zip Code CT <br /> �Lcf St' W �U 5 "-71# SCY) ' <br /> Permit/Registration Holder Name Permit Ex . ate Total Time Inspection Type <br /> } 'OBSERVATIONS AND'CORRECTk'ACTIONS <br /> Received b (Print): aam Received b (Signaturer:,/, Phone <br /> J <br /> Specialist(Print): ,QCf)1 n Fsctk6i Specialist(Signature): Phone.no 1 —J1`7S <br /> F1This 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 3 of3 <br />