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Nit <br /> A t <br /> aA I ` <br /> SAN JOAQLTT' LINTY ENVIRONMEMEN <br /> NTAL REALTI PARTT <br /> 1868 E. Hazelton Ave. • Stockton, CA 95205-6232 • Phone (209) 468-3420 <br /> Donna Heran,R.E.H.S.,Director <br /> ENVIRONMENTAL HEALTH x <br /> PERMIT TO OPERATE - 4110-BODY ART PRACTITIONER REGISTRATION <br /> Permit ID# PT0023134 for Record ID#PR0537651 <br /> Valid From 7/1/2014 To 6/30/2015 <br /> r <br /> a <br /> PERMIT TO OPERATE - 4121 -BODY ART FACILITY-STERILIZATION <br /> t .? <br /> Permit ID# PT0023135 for Record ID# PR0537652 <br /> Valid From 7/1/2014 To 6/30/2015 <br /> } <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 /> Account ID AR0039345 <br /> 13463 HWY 88 ##A Issued 5123/2014 '` <br /> LOCKEFORD CA 95237 <br /> Billing Address: ATTN : HENSON, ANTHONY G <br /> FORSAKEN TATTOO (HENSON, ANTHONY G) <br /> 14441 PROSPECT PL <br /> LOCKEFORD CA 95237 <br />