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4100 – Safe Body Art
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PR0545506
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COMPLIANCE INFO
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Entry Properties
Last modified
5/5/2023 1:11:31 PM
Creation date
5/5/2023 8:57:44 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4100 – Safe Body Art
File Section
COMPLIANCE INFO
RECORD_ID
PR0545506
PE
4110
FACILITY_ID
FA0025834
FACILITY_NAME
LIVING WATER STUDIO (MADRIGAL, ANGELO)
STREET_NUMBER
210
Direction
N
STREET_NAME
MAIN
STREET_TYPE
ST
City
MANTECA
Zip
95336
CURRENT_STATUS
02
SITE_LOCATION
210 N MAIN ST
P_LOCATION
04
QC Status
Approved
Scanner
SJGOV\cfield
Tags
EHD - Public
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San Joaquin County ! 1868 East Hazelton Avenue <br />k' Environmental Health Department Stockton, CA 95205 <br />Tel: (209) 468-3420 <br />Fax: (209) 464-0138 <br />BODY ART FACILITY AND PRACTITIONER REGISTRATION/ <br />MECHANICAL STUD AND CLASP EAR PIERCING NOTIFICATION <br />I. PROCEDED: Check all that apply (see back for definitions) Cj <br />TattooingES TO BE PERFORMBody Piercing Mechanical Stud and Clasp Ear <br />Branding OPermanent Cosmetics !AfA <br />II. REQUIRE REGISTRATION, PERMIT, OR NOTIFICATION FEES: Check all that apply. ENVII�pN O <br />1 Annual Body Art Practitioner Registration 3[::]Mechanical Stud and Clasp Ear Pi�fjR� i <br />2F__jAnnual Body Art Facility Permit�RV/Q-FS�TfI <br />III. APPLICANT INFORMATION: �Aj � <br />NAME: A vk/J) .,e_t n , vl fn AY- I U,,I.A <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> �� <br />
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