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4100 – Safe Body Art
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PR0538525
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Last modified
8/9/2024 10:07:45 AM
Creation date
5/18/2023 3:03:01 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4100 – Safe Body Art
File Section
BILLING/PERMITS
RECORD_ID
PR0538525
PE
4110
FACILITY_ID
FA0022186
FACILITY_NAME
CACTUS FLOWER (ESPARZA, SAUL)
STREET_NUMBER
1012
Direction
W
STREET_NAME
LODI
STREET_TYPE
AVE
City
LODI
Zip
95240
CURRENT_STATUS
01
SITE_LOCATION
1012 W LODI AVE STE #3
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\cfield
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EHD - Public
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SAN JOAULN COUNTY ENVIRONMENTAL HEALTH llEPARTMENT <br />Q <br />1868 E. Hazelton Ave. •Stockton, CA 95205-6232 • Phone (209) 468-3420 <br />Donna Heran, R.E.H.S., Director <br />ENVIRONMENTAL HEALTH { �j <br />PERMIT TO OPERATE 4110 BODY ART PRACTITIONER REGISTRATION ; <br />4 ft 4 <br />Permit ID # PT0023803 for Record ID # PR0538525 <br />Valid From 7/1/2013 To 6/30/2014 <br />PERMITS TO OPERATE are NOT TRANSFERABLE <br />and may be SUSPENDED or REVOKED for cause. <br />PERMIT(s) Valid only for: ESPARZA, SAUL <br />THIS FORM MUST BE DISPLAYED CONSPICUOUSLY ON THE PREMISES <br />Regulated Facility: FORSAKEN TATTOO (ESPARZA, SAUL) Facility ID FA0022186Account ID AR0040451 <br />13463 HWY 88 ##A Issued 1/29/2014 <br />LOCKEFORD CA 95237 <br />Billing Address: ATTN : ESPARZA, SAUL <br />FORSAKEN TATTOO (ESPARZA, SAUL) <br />1040 S CENTRAL AVE <br />LODI CA 95240 <br />
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