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x <br /> COUNTY ENVIRONMENTAL HEALT EPARTMENT `5 <br /> SAN JOAQUhii CO <br /> 1868 E. Hazelton Ave. • Stockton, CA 95205-6232 • Phone (209) 468-3420 <br /> �r <br /> Donna Heran,R.E.H.S.,Director <br /> 311 <br /> ENVIRONMENTAL HEALTH <br /> PERMIT TO OPERATE - 4110-BODY ART PRACTITIONER REGISTRATION <br /> Permit ID#PT0022995 for Record ID#PR0537476 <br /> Valid From 7/1/2014 To 6/30/2015 <br /> r.t <br /> i <br /> L <br /> j�,3 bw <br /> Yf <br /> s s� <br /> i <br /> s <br /> l�q <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 FA0021558 <br /> Account ID AR0039030 <br /> 8 W ELEVENTH ST Issued 5/23/2014 <br /> TRACY CA 95376 <br /> Billing Address: ATTN : ADAME, MARCOS <br /> SECRET SIDEWALK TATTOO (MARCOS ADAME) <br /> 2079 BUENA VISTA DR <br /> MANTECA CA 95337 <br />