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SAN JOAQU I TY ENVIRONMENTAL HEALT EPARTMENT <br /> 1868 E.Hazelton Ave. • Stockton,CA 95205-6232 • Phone(209)468-3420 <br /> Linda Turkatte,R.E.H.S.,Director <br /> ENVIRONMENTAL HEALTH <br /> PERMIT TO OPERATE - 4110-BODY ART PRACTITIONER REGISTRATION <br /> Permit ID# PT0025289 for Record ID# PR0541234 <br /> Valid From 8/26/2016 To 6/30/2017 <br /> j <br /> 1* <br /> 1 <br /> PERMITS TO OPERATE are NOT TRANSFERABLE <br /> and may be SUSPENDED or REVOKED for cause. <br /> PERMIT(s)Valid only for: CARBALLO,JOSE <br /> DBA: GYPSY SOUL TATTOO <br /> 4 <br /> THIS FORM MUST BE DISPLAYED CONSPICUOUSLY ON THE PREMISES <br /> Regulated Facility: GYPSY SOUL TATTOO (CARBALLO,JOSE) Facility ID FA0023622 <br /> 118 W YOSEMITE AVE Account ID AR0043650 <br /> MANTECA CA 95337 Issued 8/30/2016 <br /> Billing Address: ATTN : CARBALLO, JOSE <br /> GYPSY SOUL TATTOO <br /> 541 W LOWELL AVE <br /> TRACY CA 95376 <br /> 7027.rpt <br />