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e°`''^'• o Body Art Inspection Report <br />y County of San Joaquin County, Environmental Health Department <br />< 1868 E. Hazelton Ave., Stockton CA 95205 <br />(209) 468-3420 www.sioov.oro/ehd <br />Facilityame Address <br />S�,� U1a�i 4 <br />Permit/Registration Holder Name <br />MDQ &kmC-'CWA A� A..I V\ <br />Date (MM/DD/YY) I ALI <br />Permit Number xyigS <br />Permit Type L411I <br />City Zip Code <br />CT <br />Lid; q C.14 t) <br />Sit ,7o'UyAj' <br />Permit Exp. Date Total Time <br />Inspection Type <br />U /3 of 11 <br />'t l <br />REG #`= <br />MIXENEORGEME <br />PRACTI TIONERIARTIST NAME . <br />❑ <br />S 3b� <br />e« (Z. �� - Or` <br />35. Plan Review <br />",Uw <br />36 Permits Obtained & Available * <br />k b - 3'5- l <br />❑ <br />37. Impoundment <br />Sk4 t.Gnlck <br />❑ <br />f %.l I l 1,O <br />38. Hearing Scheduled <br />M l n b4r <br />❑ <br />39. Closure * <br />❑ <br />Items marked with an asterisk' may also havespecific requirements for tem!)0rary <br />events <br />REG #`= <br />, <br />PRAC TRIONERIARTIST NAME>l'd • • # tt REG #. <br />PRACTI TIONERIARTIST NAME . <br />S 3b� <br />e« (Z. �� - Or` <br />u� Abdul (son 4 14 WIA4 <br />",Uw <br />53h 'Yi <br />k b - 3'5- l <br />11__ <br />�'1' eJ r\ <br />Sk4 t.Gnlck <br />CvAk SAV,aV4.1.1 WQtn. 0 <br />f %.l I l 1,O <br />M l n b4r <br />6xa <br />_•, , +i *" `Nt :: ' OBSERVATIONS'AND CORRECTIVE'ACTIONS1 <br />fl6kwI" - ��,3U <br />�. �« <br />nsttoj'r' o 100" v <br />ter <br />11__ <br />�'1' eJ r\ <br />A ) ' <br />S<l,- r-03'-0 <br />f %.l I l 1,O <br />3 -- 1\�'s� <br />u1�� t� ,r tvc.�s <br />Lo <br />Coe <br />CA3-3 134 <br />`?— 11c'3 p► <br />Ilq 10 <br />- s eft- nod cisAkocaetA <br />rNr <br />0h1Jrw`- <br />-Wipkg <br />'uV i t -C.- i t' C S 41 <br />1 two ti S �, <br />t <br />W <br />tcl <br />S W; <br />r a <br />'l <br />+�►1WPfNp%n <br />14 <br />S <br />�� ► <br />�� Sin <br />a -jig <br />N. <br />v P1S n <br />Y�1 <br />1 <br />LA <br />C. u <br />lof, <br />Received by (Print): See, t Received by (Signature): Phone: <br />Specialist (Print): Specialist (Signature): Phone: <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. Reinspection Date (on or about) <br />Paged of3 <br />