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SAN°JOA �lod i _ UNW, VINIM NTt� t?P <br /> fi1868.E.Hazelton Ave. 6 Stocitt*CA 95205.6232:P-Phom(209)468-3420 r <br /> Donna Heran,R:Ea-S.,Director <br /> ENVIRONMENTAL HEALTH <br /> PERMIT TO OPERATE - 4110-BOD'Y ART PRACTITIONER REGISTRATION <br />` Permit ID# PT0024049 for Record ID# PR0538933 <br /> Valid From 6/5/2014 To 6/30/2015 <br /> a <br /> e <br /> r <br /> K <br /> v <br /> h <br /> PERMITS TO OPERATE are NOT TRANSFERABLE <br /> and may be SUSPENDED or REVOKED for cause. <br /> PERMIT(s)Valid only for: LUA, FERNANDO M <br /> DBA: GRAPE CITY TATTOOS <br /> t THIS FORM MUST BE DISPLAYED CONSPICUOUSLY ON THE PREMISES <br /> `. Facility ID FA0022362 <br /> Regulated Facility: GRAPE CITY TATTOOS (LUA, FERNANDO M) Account to AR0040910 <br /> k 830 S CENTRAL AVE issued 6/9/2014 <br /> LODI CA 95240 <br /> Billing Address: LUA, FERNANDO M <br /> 921 WELLSWOOD AVE <br /> LORI CA 95240 <br />