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r t <br /> Body Art Inspection Report Date(MM/DD/YY) ��-c L <br /> 2• y County of San Joaquin County,Environmental Health Department <br /> 1868 E.Hazelton Ave.,Stockton CA 95205 Permit Number <br /> (209)466-3420 www.sIgov.orgiehd <br /> Permit Type ot - <br /> 4�.3 F p�iii <br /> Facility Name Address city Zip Code CT <br /> Permit/Registration Holder Name Permit Exp.Date Total Time Inspection Type <br /> 35. Plan Review p <br /> 36 Permits Obtained&Available' ❑ <br /> 37. Impoundment ❑ <br /> 38. Hearing Scheduled p <br /> 39. Closure* p <br /> Items marked with an asterisk`may also havespecific requirements forternporary events <br /> REG# PRACTITIONERIARTIST NAME REG# PRACTITIONERIARTIST NAME <br /> OBSERVATIONS ANI} ORRECTIVE'ACTM, <br /> ly, Awa <br /> L <br /> 3� S <br /> ii <br /> 5 , khk t- <br /> S <br /> Received by(Print): Received by(Signature): 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 maybe charged if violations noted on this report are not corrected by the reinspection date. Reinspection Date(on or about) <br /> PageQ- of <br />