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boa , oo Body Art Inspection Report Date (MM(DDNY) <br />�. County of San Joaquin County, Environmental Health Department <br />1868 E. Hazelton Ave., Stockton CA 95205 <br />Permit Number <br />/ (209) 468-3420 www.sioov.org/ehd Permit Type <br />Facility Name Address City Zip Code CT <br />Permit/Registration Holder Name Permit Exp. Date Total Time Inspection Type <br />nRS-RVATioNS'AND CORRECTIVE ACTIMS <br />Id��.I%wL�.i WIl/ I I M ITA <br />�i11�►7ItTi�'���71,r �ic'7��1���:� <br />i11A M- <br />1 <br />�u—�C / Yn <br />�zege- <br />Received b (Print): Received b (Signature): <br />�� kf <br />Specialist Print Specialist (Signature): <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. <br />Paae5 of <br />Phone: Gv /I U/` 0 L%'r�� <br />Phone: <br />Reinspection Date (on or about) <br />