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ENVIPSYNMENTAL.HEALTH <br /> PERMIT TO OPERATE - 4110-BODY ART PRACTITIONER REGISTRATION <br /> Permit ID# PT0025326 for Record ID#PRO541300 <br /> Valid From 9/22/2016 To 6/30/2017 <br /> i <br /> (500#1 xeti#4 <br /> Presented to <br /> SCOTT BENDER <br /> BBPRCOHPM 191931 <br /> having successfully completed Cathy Montie's Body Art Training Company's <br /> and has passed a test in accordance with the educational requirements for tattoo artists <br /> as specified under Cal/OSHA Title 8,section 5193 and Federal OSHA 29CFR 1910.1030. <br /> 9 <br /> Cathy Montiej�s��'bglo7ixol� <br /> vAuoniaouoHosiorizole Authorized General Industry <br /> • Outreach Trainer <br /> d <br /> PERMITS TO OPERATE are NOT'TRANSFERABLE <br /> and may be SUSPENDED or REVOKED for cause. <br /> PERMIT(s)Valid only fora BENDER, SCOTT <br /> DBA: TIME HONORED TRADITION LLC <br /> THIS FORM MUST BE DISPLAYED CONSPICUOUSLY ON THE PREMISES <br /> /mated Facility: EMERALD TATTOO &PIERCING (BENDER, Si Facility ID FA0023660 <br /> 2525 S HUTCHINS ST##8 Account ID AR0043765 <br /> LODI CA 95240 Issued 9/22/2016 <br /> 3illing Address: ATTN : BENDER, SCOTT <br /> EMERALD TATTOO & PIERCING <br /> 9417 MIRANDY DR <br /> SACRAMENTO CA 95826 <br /> A <br />