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1 Received by (Print): Received by (Signature): Phone: Specialist (Print) Specialist (Signature): Phone: ❑This report is an Official Notice of Violation. Corrections must be completed in the time specified. A reinspection fee may be charged if violations noted on this report are not corrected by the reinspection date. Reinspection Date (on or about) Pane Zia ;N� to A . o Body Art Inspection Report Date (MM/DDNY) 1117 7 1 County of San Joaquin County, Environmental Health Department Permit Number FArdWA 1868 E. Hazelton Ave., Stockton CA 95205 L �. LCM/ (209) 468-3420 www.sigov.orglehd Permit Type 4-1 cx a`IfiGR�� Facility Name Address City Zip Code CT Permit/Registration Holder Nam& Permit Exp. Date If Total rime Inspection TYW a I ; _ . A _ 1 /- --.)e" —13 -zP&,,hk i 2c.-hw- 1 Received by (Print): Received by (Signature): Phone: Specialist (Print) Specialist (Signature): Phone: ❑This report is an Official Notice of Violation. Corrections must be completed in the time specified. A reinspection fee may be charged if violations noted on this report are not corrected by the reinspection date. Reinspection Date (on or about) Pane Zia FArdWA L �. LCM/ ".01 JOWTZMA' I ri III R L i 1/ • � RRIMMM - - M ■ V M sv 19 WA-01ll if�rl i rr I / � / ! �L ! _ t•� MUM= SON 1 Received by (Print): Received by (Signature): Phone: Specialist (Print) Specialist (Signature): Phone: ❑This report is an Official Notice of Violation. Corrections must be completed in the time specified. A reinspection fee may be charged if violations noted on this report are not corrected by the reinspection date. Reinspection Date (on or about) Pane Zia