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s = ,t <br />( AN d4AQUIlVOUNTY ENVIRONMENTAL HEALT DEPARTMENT'=,•.�a <br /> 1868 E.Hazelton Ave. • Stockton, CA 95205-6232 • Phone(209)468-3420 ; <br /> s Donna Heran,R.E.H.S.,Director <br /> f' <br /> ENVIRONMENTAL HEALTH <br /> % . k PERMIT TO OPERATE - 4110-BODY ART PRACTITIONER REGISTRATION <br /> — <br /> 9' ^ Permit ID# PT0024377 for Record ID#PR0539622 <br /> Valid From 11/17/2014 To 6/30/2015 <br /> 4 ' v <br /> ;{ lel . <br /> h: Y <br /> Al <br /> y <br /> t . <br /> • <br /> a <br /> _ <br /> - , <br /> K <br /> G{k A _. f .td t .1 br.:..- t+F•narx.,.. .4AMSA ke. ,4+ .' M°� 3 r" <br /> }may 4y d4 , ... <br /> 4- <br /> PERMITS TO OPERATE are NOT TRANSFERABLE , <br /> x and may be SUSPENDED or REVOKED for cause. <br /> PERMIT(s)Valid only for: HAYNES, JOHN <br /> THIS FORM MUST BE DISPLAYED CONSPICUOUSLY ON THE PREMISES <br /> PW <br />'Y Regulated Facility: LOTUS PIERCING &TATTOOING (HAYNES, Ji Facility ID FA00226.69 #w <br /> Account iD AR0041.509 <br /> 3200 N NAGLEE ST 116 <br /> issued 11/18/2014 <br /> TRACY CA 95304 <br />} <br /> B illing Address: ATTN : HAYNES, JOHN <br /> LOTUS PIERCING &TATTOOING (HAYNES, JOHN) <br /> Vit, 3200 N NAGLEE RD STE 116 <br /> j TRACY CA 95304 <br /> • <br />