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SAN JOAQUIMUNTY ENVIRONMENTAL HEALT PARTMENT <br /> 1868 E.Hazelton Ave. • Stockton,CA 95205-6232 • Phone(209)468-3420 <br /> Linda Turkatte,R.E.H.S.,Director <br /> ENVIRONMENTAL HEALTH <br /> PERMIT TO OPERATE - 4110-BODY ART PRACTITIONER REGISTRATION <br /> Permit 1D# PT0025203 for Record ID# PR0541071 <br /> Valid From 7/1/2017 To 6/30/2018 <br /> PERMITS TO OPERATE are NOT TRANSFERABLE <br /> and may be SUSPENDED or REVOKED for cause. <br /> PERMIT(s)Valid only for: FREDRICKSEN, ROBERT <br /> DBA: FORSAKEN TATTOO <br /> THIS FORM MUST BE DISPLAYED CONSPICUOUSLY ON THE PREMISES <br /> Regulated Facility: FORSAKEN TATTOO (FREDERICKSEN, ROBE Facility ID FA0023514 <br /> 13500 HWY 88 Aunt ID AR0043358 <br /> LOCKEFORD CA 95237 Issued 5/31/2017 <br /> Billing Address: ATTN : FREDERICKSEN, ROBERT <br /> FORSAKEN TATTOO <br /> 5705 LARCOM LN <br /> STOCKTON CA 95210 <br /> 7027.rpt <br />