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F �> <br /> y` SAN JOAQUIN COUNTY ENVIRONMENTAL HEALT DEPARTMENT <br /> 1868 E. Hazelton Ave. • Stockton,CA 95205-6232 • Phone (209) 468-3420 <br /> Donna Heran,R.E.H.S., Director '`` ti <br /> �r <br /> ENVIRONMENTAL HEALTH <br /> PERMIT TO OPERATE - 4110-BODY ART PRACTITIONER REGISTRATION t <br /> til",t <br /> Permit ID# PT0023136 for Record ID# PRO537653 <br /> Valid From 7/1/2013 To 6/30/2014 <br /> t <br /> Ij <br /> a <br /> A, tti �..i <br /> u <br /> J d <br /> . <br /> e S <br /> r fi k <br /> x,cJit <br /> � <br /> 3f <br /> 4 x <br /> r 4, <br /> �t, y y <br /> .d i <br /> :4 <br /> oJ , ¢hz <br /> & Aa <br /> az, <br /> t dbx,n"F <br /> ¢ J s t7 Q, t+ x wy <br /> F <br /> � 9 <br /> yt <br /> PERMITS TO OPERATE are NOT TRANSFERABLE <br /> and may be SUSPENDED or REVOKED for cause. <br /> PERMIT(s)Valid only for: QUEZADA,JESSE <br /> THIS FORM MUST BE DISPLAYED CONSPICUOUSLY ON THE PREMISES <br /> Facility ID FA0021688 <br /> Regulated Facility: BLACK ROSE TATTOO (QUEZADA,JESSE) <br /> Account ID AR0039346 <br /> 237 E MINER AVE 4 <br /> STOCKTON CA 95202-2328w. Issued 6/4/201 <br /> ,- i Y <br /> ;r <br /> Billing Address: ATTN : QUEZADA, JESSE <br /> BLACK ROSE TATTOO (QUEZADA, JESSE) <br /> 334 E 21 ST ST <br /> TRACY CA 95376 <br /> s Ig3•x,fir <br />