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SAN JOAQUIN UOUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 E.Hazelton Ave. • Stockton, CA 95205-6232 • Phone (209) 468-3420 4VIC, , <br /> x <br /> Donna Heran,R.E.H.S.,Director B „ <br /> ENVIRONMENTAL HEALTH <br /> PERMIT TO OPERATE - 4110-BODY ART PRACTITIONER REGISTRATION <br /> Permit ID# PT0022995 for Record ID# PRO537476 <br /> Valid From 7/1/2013 To 6/30/2014 <br /> g$,, ' <br /> e y r+i 'x <br /> a ;fit P " s e , <br />!t �' r. .` .s kw a, s,r w� <br /> 4 <br /> gi <br /> PERMITS TO OPERATE are NOT TRANSFERABLE <br /> and may be SUSPENDED or REVOKED for cause. <br /> PERMIT(s)Valid only for: MARCOS, ADAME <br /> THIS FORM MUST BE DISPLAYED CONSPICUOUSLY ON THE PREMISES <br /> Regulated Facility: SECRET SIDEWALK TATTOO (MARCOS ADAI Facility ID FA0021558Account ID AR0039030 <br /> W ELEVENTH ST <br /> Issued 6/412013 <br /> TRACY CA 95376 <br /> Billing Address: ATTN : ADAME, MARCOS <br /> SECRET SIDEWALK TATTOO (MARCOS ADAME) ' <br /> 2079 BUENA VISTA DR � t <br /> MANTECA CA 95337 <br /> LIM <br /> k <br />