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SAN JOAQU10OUNTY ENVIRONMENTAL HEALTSEPARTIVIENT ,� z � "' xr <br /> 1868 E. Hazelton Ave. • Stockton, CA 95205-6232 Phone(209)468-3420 <br /> Donna Heran,R.E.H.S., Director <br /> ENVIRONMENTAL HEALTH. <br /> �,- <br /> PERMIT TO OPERATE - 4110-BODY.ART PRACTITIONER REGISTRATION <br /> k Permit ID# PT0023136 for Record ID# PR0537653 <br /> k Valid From 7/1/2014 To 6/30/2015 " <br /> t <br /> §a: <br /> k <br /> 'S• k a H `t, #ph, r�,> adr�t 4 -' " 7St 5 y t , 5 <br /> *�gav .�� 1 v a � T�'4tc�n . <br /> +w3 ,� w3 a ..: ? a� � s vrf <br /> 5�:''a� `��x�ar� ,i. SSC � '� � � } v �. �, ��z?.• r �� <br /> 1 WIT <br /> dg *e�-� x� a� 3 v'y, �'�;:; �£? f � `'��hw✓ �rt �xt� r9 ,. y '�s€ w "� <br /> xy ,' w Y: arg. <br /> : -s "t k E ,� 3++ E N�" .a A`� 4b r 't b : °" b g, p}x•{ 4 �'' , f:r S r a <br /> 2 z, <br /> p:8 '` iY, t +(; r ,r , "' L w xa a r'q } T & '.,a•. z axe q'c <br /> d ..,zzyxvyt s+ a r' <br /> ,. k..`,1 rz'S <br /> y <br /> W <br /> K <br /> u,S€ <br /> r y <br /> PERMITS TO OPERATE are NOT TRANSFERABLE <br /> and may be SUSPENDED or REVOKED for cause. <br /> PERMIT(s)Valid only for QUEZADA,JESSE � ,� �r, „ � � 1 <br /> NOW <br /> THIS FORM MUST BE DISPLAYED CONSPICUOUSLY ON THE PREMISES <br /> 4 i av:k <br /> Facility io FA0021688AR <br /> Regulated Facility: BLACK ROSE TATTOO (QUEZADA, JESSE) $�5„ Account ID AR0039346 # ' ; <br /> 237 E MINER AVE issued 5/23/2014 <br /> STOCKTON CA 95202-2328 _, <br /> Billing Address: ATfN : QUEZADA, JESSE �t �` ' <br /> BLACK ROSE TATTOO (QUEZADA, JESSE) <br /> 334 E 21 ST ST �� <br /> TRACY CA 95376 <br /> t <br /> F� <br />