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Date (MM/DDNY) P C-1-3 <br />o Body Art Inspection Report <br />County of San Joaquin County, Environmental Health Department Permit Number Z16 sa-3 <br />1868 E. Hazelton Ave., Stockton CA 95205 <br />(209) 468-3420 www.sigov.ora/ehd <br />Permit Type <br />Facility Name Address city Zip Code CT <br />-" A). act-jj*e) M"+&i qffu)Q�l �ictn <br />PermittRegistration Holder Name Permit Exp. Date Total Time Inspection "rype <br />I <br />0 <br />0 <br />0 <br />Ir A <br />Received by (Print): Received py (signature r SJ rnone: <br />Specialist (Print) Specialist (Signature): Phone: <br />F1This 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 />PaQez of 6 <br />