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7 :. <br /> a i d4- <br /> 7 t r `' <br /> w <br /> SAN JOAQUTNOUNTYNO 'i�`AL HEALTH DEPN' ' <br /> 1868 E..Hazelton Ave. oStool t*to 9520 6232 •Phonic(Z04)ilt - Z0 <br /> Donna.Heran;R:E.H.S: Director A <br /> - '. :... .. ✓'e ... is - !ter' <br /> ENVIRONMENTAL HEALTH <br /> b PERMIT TO OPERATE — 4110-BODY ART PRACTITIONER REGISTRATION <br /> 9 ? <br /> ra ' Permit ID# PT0023054 for Record ID# PR0537548 <br /> 4 = Valid From 7/1/2012 To 6/30/2013 <br /> x � , <br /> PERMITS TO OPERATE are NOT TRANSFERABLE <br /> and may be SUSPENDED or REVOKED for cause. <br />�e <br /> PERMIT(s)Valid only for: CORONILLA, HENRY <br />�k * <br /> THIS FORM MUST BE DISPLAYED CONSPICUOUSLY ON THE PREMISES <br /> Facility ID FA0021616 <br /> � 5 Regulated Facility: INK CITY TATTOO (CORONILLA, HENRY) Account ID AR0039162 <br /> 3008 E HAMMER LN # 124 <br /> q STOCKTON CA 95212 issued 1/18/2013 <br />� I <br /> Billing Address: ATTN : CORONILLA, HENRY <br /> INK CITY TATTOO (CORONILLA, HENRY) <br /> 3008 E HAMMER LN #124 <br /> STOCKTON CA 95212 <br /> s <br />