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R <br /> 71 <br /> SAN JOA A, COUNTY ENVIRONMENTAL HE L - <br /> Q NVIRON ALZtt DEPARTMENT <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 7/1/2015 To 6/30/2016 <br /> PERMIT TO OPERATE - 4121 -BODY ART FACILITY-STERILIZATION <br /> Permit ID# PT0023135 for Record ID# PRO537652 <br /> Valid From 7/1/2015 To 6/30/2016 <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 G) Facility ID FA0021687 <br /> 13463 HWY 88 ##A <br /> Account ID AR0039345 LOCKEFORD CA 95237 Issued 5/28/2015 <br /> Billing Address: ATTN : HENSON, ANTHONY G <br /> FORSAKEN TATTOO (HENSON, ANTHONY G) <br /> 14441 PROSPECT PL <br /> LOCKEFORD CA 95237 <br /> 7027.rpt <br />