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a I • c Body Art Inspection Report Date(M►UUDD/YY) <br /> a ti� County of San Joaquin County,Environmental Health Department <br /> 1868 E.Hazelton Ave.,Stockton CA 95205 Permit Number <br /> (209)468-3420 www.sigov.oro/ehd <br /> Permit Type I <br /> Facility Name Address City Zip Code CT <br /> ice.®k l >�!t ,✓ Afte, 3 Sr:xt& <br /> Permit(Registration Holder Name Permit Exp.Date Total Time Inspection TyVe <br /> / / 4-2 <br /> r -16 <br /> 1 i <br /> �t <br /> r <br /> ® 6 <br /> AILIJ <br /> V <br /> kZ16 t!Yr1j'-"6M JZ Q� OAA <br /> L .-.— <br /> I , �l <br /> 1 <br /> e <br /> r' <br /> !- <br /> Received b Print): m L 1 Received b (Signature): Phone: 5 <br /> Specialist(Print): Specialist Si nature Phone - <br /> This report is an Official Notice of Violation.Corrections must be completed in the ' p cified. <br /> A reinspection fee may be charged if violations noted on this report are not corrected by a reinspection date. Reinspection Date(on or about) <br /> Paoe of'—'I <br />