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0 <br />Body Art Inspection Report <br />County of San Joaquin County, Environmental Health Department <br />1868 E. Hazelton Ave., Stockton CA 95205 <br />(209) 488-3420 www.sigov.org/ehd <br />Facility Name Address <br />0% z- !:a LLM4 -6ri <br />Permit/Registration Holder Name <br />A- , T-- -% , <br />E <br />Date(MWDD/YY) 11 -C9!? -1 <br />Permit Number <br />Permit Type 4-1 tQ <br />city Zip Code CT <br />iy/-K4-yY,, q sac �( vx <br />Permit Exp. Date Total Time Inspection Tk <br />=Z71L [ <br />YiS <br />Received by (Print): Received by Ysignature): t Phone: <br />Specialist (Print): Specialist (Signature): Phone: <br />This 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 />Paoe3of Ll <br />1�A 15 <br />'A <br />'711111TIM I <br />low <br />LM K "AMM� M t! I j <br />IPA Al <br />PAT - <br />If i M W -M -M-0- 1 <br />A <br />P77"ME-70 <br />MM M 03 1 Wrs% = E Awl 1110 MOTTYAM- <br />A W <br />11, MAMM <br />�M=-M,�: 9 W <br />0111111 i 0 -Mr, <br />YiS <br />Received by (Print): Received by Ysignature): t Phone: <br />Specialist (Print): Specialist (Signature): Phone: <br />This 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 />Paoe3of Ll <br />