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SAN JOAQUInUNTY ENVIltONMENTAL HEALTI0kPARTMENT <br /> f <br /> A ' < 1868 E.Hazelton Ave. • Stockton,CA 95205-6232 a Phone(209)468-3420 <br /> All <br /> f <br /> M Donna Heran,R.E.H.S.,Director <br /> f� <br /> ENVIRONMENTAL HEALTH <br /> p Y ' PERMIT TO OPERATE - 4110-BODY ART PRACTITIONER REGISTRATION ' <br /> t <br /> Permit ID# PT0023002 for Record ID# PR0537483 <br /> Valid From 7/1/2013 To 6/30/2014 <br /> T yt <br /> , <br /> a , <br /> h <br /> " <br />- <br /> VK <br /> l <br /> t <br /> PERMITS TO OPERATE are NOT TRANSFERABLE <br /> and may be SUSPENDED or REVOKED for cause. <br /> PERMIT(s)Valid only for: AZEVEDO, JEREMY D <br /> THIS FORM MUST BE DISPLAYED CONSPICUOUSLY ON THE PREMISES <br /> Regulated Facility: BLACK ROSE TATTOO (AZEVEDO, JEREMY[ Facility ID FA0021565 <br /> Account ID AR0039037 <br /> 237 E MINER Issued $/16/2013 <br /> STOCKTON CA 95206 <br /> Billing Address: ATTN : AZEVEDO, JEREMY D <br /> BLACK ROSE TATTOO (AZEVEDO, JEREMY D) <br /> 1401 QUEEN <br /> 5203 <br /> STOCKTON CA 9 <br /> t� <br />