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San Joaquin Coun'tV <br />Environmental Health Department - <br />1868 East Hazelton Avenue <br />Stockton, CA 95205 <br />Tel: (209) 468-3420 <br />Fa),,: (209) 464-0138 <br />BODY ART FACILITY AND PRACTITIONER REGISTRATION/ <br />MECHANICAL STUD AND CLASP EAR PIERCING MOTIFICATnON <br />I. PROCEDURES TO BE PERFORMED: Check all that apply (see back for definitions) <br />rVITattooing ®Body Piercing ®Mechanical Stud and Clasp Ear Piercing <br />Acaq <br />Branding MPermanent Cosmetics <br />II. REQUIRED REGISTRATION, PERMIT, OR NOTIFICATION FEES: Check all that apply. <br />nual Body Art Practitioner Registration 3®Mechanical Stud and Clasp Ear Piercing Notification <br />nual Body Art Facility Permit <br />III. APPLICANT INFORMATION: <br />NAME: <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 />/A <br />