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n <br /> 471 <br /> SAN JOAQUI OUNTY ENVIRONMENTAL HEALTODEPARTMENT <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# PT0023134 for Record ID# PR0537651 <br /> Valid From 7/1/2016 To 6/30/2017 <br /> PERMIT TO OPERATE - 4121 -BODY ART FACILITY-STERILIZATION <br /> Permit ID# PT0025175 for Record ID# PR0541030 <br /> Valid From 7/1/2016 To 6/30/2017 <br /> PERMITS TO OPERATE are NOT TRANSFERABLE <br /> and may be SUSPENDED or REVOKED for cause. <br /> PERMIT(s)Valid only for: HENSON, ANTHONY G <br /> THIS FORM MUST BE DISPLAYED CONSPICUOUSLY ON THE PREMISES <br /> Regulated Facility: FORSAKEN TATTOO (HENSON, ANTHONY) Facility ID FA0023492 <br /> 13500 HWY 88 Account iD AR0043308 <br /> LOCKEFORD CA 95237 issued 5/27/2016 <br /> Billing Address: ATTN : HENSON, ANTHONY G <br /> FORSAKEN TATTOO (HENSON, ANTHONY) <br /> 14441 PROSPECT PL <br /> LOCKEFORD CA 95237 <br /> 7027.rpt <br />