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d ' a � 1`r <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENTEr , x <br /> 1868 E. Hazelton Ave. • Stockton,CA 95205-6232 • Phone (209)468-3420xp. <br /> Vtt a <br /> r Donna Heran,R.E.H.S., Director ,. .� <br /> xF* <br /> ENVIRONMENTAL HEALTH } <br /> ov, <br /> PERMIT TO OPERATE - 4110-BODY ART PRACTITIONER REGISTRATION <br /> .; <br /> ` Permit ID# PT0022921 for Record ID# PRO537406 <br /> Valid From 7/1/2013 To 6/30/2014 <br /> �+.+- ��.rs', <br /> #' x. p� $d,p� ro zT ..u.S t ✓q <br /> Nf <br /> o q k sa t d R <br /> t: i sj kf e � <br /> �gp- jA <br /> +> ,a,,,.�.4r <br /> a .,c <br /> �{�"�r., >t v <br /> v a <br /> t .�� <br /> w 'r' <br /> } x <br /> qip <br /> ✓ a �u <br /> PERMITS TO OPERATE are NOT TRANSFERABLE <br /> and may be SUSPENDED or REVOKED for cause. <br /> PERMIT(s)Valid only for: CARMONA, ULICES <br /> DBA: BLACK ROSE TATTOO <br /> THIS FORM MUST BE DISPLAYED CONSPICUOUSLY ON THE PREMISES <br /> Regulated Facility: BLACK ROSE TATTOO (ULICES CARMONA) Facility ID FA0021506 <br /> 237 E MINER AVE Account ID AR0038914 :� t <br /> STOCKTON CA 95202 `< '�` Issued 6/4/2013 <br /> Billing Address: ATTN : CARMONA, ULICES d� <br /> ti va�'�`'�? <br /> BLACK ROSE TATTOO (ULICES CARMONA) IV <br /> _a t ` z <br /> x t <br /> 237 E MINER AVEC _ < <br /> STOCKTON CA 95202 ._ x �� y s n <br /> 46 <br /> g. <br /> ::; <br />