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COMPLIANCE INFO
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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KETTLEMAN
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521
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4100 – Safe Body Art
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PR0546258
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COMPLIANCE INFO
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Entry Properties
Last modified
3/5/2025 3:30:14 PM
Creation date
4/18/2023 11:18:11 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4100 – Safe Body Art
File Section
COMPLIANCE INFO
RECORD_ID
PR0546258
PE
4120 - BODY ART FACILITY-SINGLE USE
FACILITY_ID
FA0026192
FACILITY_NAME
OLD VINE TATTOO (PALMER, JOSH)
STREET_NUMBER
521
Direction
W
STREET_NAME
KETTLEMAN
STREET_TYPE
LN
City
LODI
Zip
95242
CURRENT_STATUS
Inactive, non-billable
QC Status
Approved
Scanner
SJGOV\cfield
Supplemental fields
Site Address
521 W KETTLEMAN LN LODI 95242
Tags
EHD - Public
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Address: Old Vine Tattoo—521 W Kettleman Ln, Stockton, CA 95242 Record ID: PR0546258 <br /> Uate: //2//2'1 <br /> PHOTO 4: Invoice for instruments. <br /> mall <br /> --"' k�-k(Idw ta.A P(Inl❑' lnr"Nriu1U--1I <br /> Black Claw USA <br /> 4201 St Woodstock Blvd.#478 <br /> i P-rtland OR 97206 .':_. .e%.i <br /> Billing Details Shipping Details ^ <br /> yF .Josh Palmer josh palmar <br /> 1595 Cowens Ln 1595 Cowens Ln <br /> Lodi,California 95242 Lodi,California 95242 <br /> r` United States United States <br /> 1 ! k <br /> Phone:2093959553 Phone.2093959553 <br /> Email.jpaimerftw@yahoo.com Email.jpalmerftw@yahoo.com <br /> ;j Order: #107711 Order Date: Jun 19th 2021 <br /> Payment Method: Braintree(PayPal)($467.49) Shipping Method: US Delivery(Standard-8-12 <br /> business days) <br /> Order Items <br /> Uty Code/SKU Product Name Price Total <br /> 2 BC-15CM Medium Taper 15 Curved Magnum $38.00 USD $76.00 USD <br /> 1 BC-15CMLT Long Taper 15 Curved Magnum $38.00 USD $38.00 USD <br /> 3 BC-9RT Real Steel 9 Round Disposable Tube $25.00 USD $75.u0 U5U x. <br /> 4 BC-7RT Real Steel 7 Round Disposable Tube $25.00 USD $100 00 USD <br /> 2 8C-5RT Real Steel 5 Round Disposable Tube $25.00 USD $50.00 USD <br /> ti <br /> s 3 BC-15FT Real Steel 15 Magnum Disposable Tube $25.00 USD $75 00 USD <br /> Subtotal $414 00 USD <br /> �Y <br /> Shipping $10.30 USD <br /> Tax $34.19 USD <br /> Grand Total: $467.49 USD <br /> i <br /> Pinne Chao, Environmental Health Specialist Page 4 of 12 <br />
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