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� AQ tifry / <br /> Body Art Inspeco Report Date: <br /> San Joaquin County Environmental Health Department Program <br /> 1868 E.Hazelton Ave.,Stockton,CA 95205 Record: <br /> (209)468-3420 Program <br /> www.siogv.org/ehd <br /> Element: <br /> PR Number PRACTITIONER/ARTIST NAME PR Number PRACTITIONER/ARTIST NAME <br /> Briana Gonzales-BBP available,permit to be <br /> PRO542097 obtained <br /> Observations and Corrective Actions: <br /> 18. The facilities client consent form and medical questionnaire must include all of the information listed in Form B, and are <br /> available for inspection. HSC 119303 <br /> 37. A body art facility shall not conduct business without a valid health permit. A person shall not perform body art without a valid <br /> registration and a permitted facility. A body art facility shall notify the LEA in writing within 30 days of resignation, termination of a <br /> practitioner. Anew hire or apprentice must be registered the EHD prior to performing body art at the facility. HSC 119312 & <br /> 119306 <br /> Correct all violations listed above prior to opening facility. <br /> Notes: <br /> 1.) Facility is okay to open once permit has been obtained from EHD. <br /> 2.) Business moved from 539 W. Eleventh Street, Tracy, CA (PR0542096).. <br /> Reinspecion on/about: A reinspection fee of$130 per hour may be charged. Page 2 of 2 <br /> EH-03/2015 <br />