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0 0 <br /> o av! Body Art Inspection Report Date(MM/DD/YY) <br /> y County of San Joaquin County,Environmental Health Department <br /> 1868 E.Hazelton Ave.,Stockton CA 95205 Permit Number <br /> (209)468-3420 vwvw.sj oA v.orglehd <br /> Permit Type <br /> Facility Name Address City Zip Code CT <br /> ,V- <br /> Permit/Registration Holder Name Permit Exp.Date Total Time Inspection ype <br /> �v&e <br /> . . CEIrlE. our TRAINING PROVIDED <br /> 35. Plan Review p <br /> 36 Permits Obtained&Available* ❑ <br /> 37. Impoundment ❑ <br /> 38. Hearing Scheduled ❑ <br /> 39. Closure* p <br /> Items marked with an asterisk*may also havespecific requirements for temporaryevents <br /> REG# PRAC7ITIONERIARTISTNAME REG# t ?RAfff ONERlARTIST NAME <br /> 0.All -Fieyw-, rrrsl 4 A C(`(RRiECTNEACTtit'I1�" * <br /> J I <br /> l ► <br /> 0 <br /> ,v <br /> 9,l A I a q ej k AAs [ s <br /> ►ti <br /> Received b (Print): Received by(Signature): Phone: <br /> Specialist(Print): Specialist(Signature): Phone: <br /> ❑ This report is an Official Notice of Violation.Corrections must be completed in the time specified. <br /> A reinspection fee may be charged if violations noted on this report are not corrected by the reinspection date. Reinspection Date(on or about) <br /> Paget-of <br />