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t <br /> SAN JOAQUIl*OUNTY ENVIRO'NMENTAL HEALT*EPARTMENT <br /> 1868 E.Hazelton Ave. • Stockton,CA 95205-6232 • Phone(209)468-3420 <br /> Linda Turkatte,R.E.H.S.,Director <br /> ENVIRONMMENTAL HEALTH <br /> PERMIT TO OPERATE - 4110-BODY ART PRACTITIONER REGISTRATION <br /> Permit ID# PT0023053 for Record ID#PR0537547 <br /> Valid From 7/1/2018 To 6/30/2019 <br /> PERMITS TO OPERATE are NOT TRANSFERABLE <br /> and may be SUSPENDED or REVOKED for cause. <br /> PERMIT(s)Valid only for: VASQUEZ, SAMUEL <br /> DBA: THE BLACK ROSE TATTOO PARLOR <br /> THIS FORM MUST BE DISPLAYED CONSPICUOUSLY ON THE PREMISES <br /> Regulated Facility: BLACK ROSE TATTOO PARLOR,THE Facility ID FA0021614 <br /> 237 E.MINER AVE Account ID AR0039160 <br /> STOCKTON CA 95202 Issued 5/2/2018 <br /> Billing Address: ATTN : VASQUEZ, SAMUEL <br /> BLACK ROSE TATTOO PARLOR, THE <br /> 237 MINER AVE <br /> STOCKTON CA 95202 <br /> yo2z.rpc <br />