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1 <br /> ?� <br /> PUBLIC HEALTH ' SERVICES <br /> ENVIRONMENTAL HEALTH DMSION <br /> Kitten Ftirst, .,M.P14., HeWdi Officcr C'`•, <br /> 304 Eat Weber Aventm,Third Fluor -$tcckion, CA 93202 APR 0 ? <br /> 2091469-3420 <br /> qp99 yy tt ��}} q p g q} <br /> �fy�t4t�L�f'4i4s�.`,Mi i�1:.FtiL1}-9 <br /> APPLICA110N FOR REGISTRATION <br /> TAITPOING4 000Y PILRCING, IC <br /> hwom ti C91forals flealth and 5a Code.Chapter 7,Secticni 119NO <br /> VILtA <br /> ngPP as !Y� tre <br /> F cl9a 9 t)ap o,+ <br /> a,%it i u NSan!iit ea9 rXilkin 6Vlthin camy oem V4 ftwic ad adtitmes an battl <br /> rA" r de <br /> .Mailing Address <br /> Chy,State,Do - <br /> ttr �e--- a tt i rtxvl 0 / <br /> ti'd.d-- --Insetting pigment wder the s"ce of the skin bY ptieWris with 8 1109tild or <br /> otherwise, to pernumently chmge the color ora die skim or to produce aq ilidellble <br /> mak or figure visible througk the skirt. 11is includes but is not limited to, eyeliqtr, lip col t, <br /> canjouflago,3tctie:' desigm and free hanitt designs. <br /> v is in — t' n taf ope 'e bU �► or of <br /> i t ' jewe r r floti, is ' cl es is not lit t , piercin , li <br /> - <br /> tongue. nose or eytbruw. Body piricing does not, for die Purpose of Us definitim indudd <br /> piercing the leading a or eorliobc of die eat with it sterile,disposable. shi le-use stud or solid <br /> needle that is applied ing a triechanical device to fame the needle or stud�dffi h tete <br /> e d QaKda — Illep icsit of pigiRtent to or ± i t skirt of <br /> being ror the purpom of pemiairmily changing dicLului of ution appcHrancr, of a <br /> includes,but is not lingled to,permanent eyeliner.eyes ow,or lip calor-. ,�l <br /> E declare doit tv dao bink 9f my knowledSd the information that t have Provided is tn[R-Ovid ncctat:tte. t also agrcc to <br /> confbrot to all condiftis,ordets and direr is. issued purstimit to the Callibmilt 1jealth and Safery C nil <br /> applicable Comy and City Otdiontices. <br /> Sid0dW1 A31303-1 d2a :eo To 20 Row <br />