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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 />