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lo '-. <br /> /�o`""'•. o Body Art Inspection Report Date(MM1DD/YY) 5`'-� <br /> (• y County of San Joaquin County,Environmental Health Department <br /> !!! < 1868 E.Hazelton Ave.,Stockton CA 95205 Permit Number ��CJt»o23/t�oZ <br /> . <br /> . <br /> (209)468-3420 www.sigov.org/eh Permit Type <br /> Facility Name Address City Zip Code CT <br /> PermittRegistration Holder Name Permit Exp.Date Total Time Inspection Type <br /> .Zn.vf-+rL 1 <br /> f 3C� 13 <br /> 35. Plan Review ❑ <br /> 36 Permits Obtained&Available` ❑ <br /> 37. Impoundment ❑ <br /> 38. Hearing Scheduled p <br /> 39. Closure* ❑ <br /> Items marked with an asterisk'may also have specific requirements for temporary events <br /> REG 9', PRACTITiOINER(ARTIs`T NAME REG#. PRACTITI0NE0I4RTI5T NAME , <br /> 0I3SERVA*NS AND CORRECTIVE ACT![?HS <br /> tdfic <br /> �5f <br /> e% <br /> f- 1h t4 <br /> r <br /> 4-2-(zodbL' <br /> Received b Print: 7 Received b (Signature): <br /> Phone: j>Z �{ X38 <br /> A60 <br /> a <br /> Specialist Print): Specialist Signatur - Phone: -7 <br /> ` <br /> ❑ This report is an Official Notice of Violation.Corrections must be completed in theme led. <br /> A reinspection fee may be charged if violations noted on this report are not corrected b e reinspection date. Reinspection Date(on or about) <br /> Page of <br />