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0 <br />Body Art Inspection Report <br />r ,y� County of San Joaquin County, Environmental Health Department <br />s 1868 E. Hazelton Ave., Stockton CA 95205 <br />(209) 468-3420 www.siaov.ora/ehd <br />Date (MM/DD/YY) 3 <br />Permit Number <br />Permit Type <br />Faclllijility N}a�Jm Address city Zip Code <br />T T <br />D , l pD 1 0 4 5),o <br />Permit/Registration Holder Name Permit Exp. Date Total Time Inspection Type <br />— % O --• , <br />JTe %& n b"iol'w eJ S <br />�l <br />r � <br />Ir 1�M5 M MUMIXIMMIATIM Alta 111111111 <br />1 r. s: ./, ♦.iia �'. <br />MIT MEN <br />i. <br />— !MRSE <br />A$ <br />22 <br />Received b (Print): Received by (Signature): Phone: <br />Specialist (Print) Specialist (Signature): Phone: <br />This report is an Official Notice of Violation. Corrections must be completed in the time specified. <br />A reinspection fee may be charged if violations noted on this report are not corrected by the reinspection date. Reinspection Date (on or about) <br />Pagea of <br />