Laserfiche WebLink
W° <br />"$ <br />San Joaquin County <br />Environmental Health Department <br />Gender: F o M circle one) <br />1868 East Hazelton Avenue <br />A 95205 <br />Stockton) (209 )) 468-3420 <br />Identification No.: <br />Facility where B Art Services Will be Provided <br />Fax: (209) 464-0138 <br />-Tel oyffil -- T, 1 0 i • • <br />I. PROCEDURES TO BE PERFORMED: Check all that apply (see back for definitions) <br />EELTattooing Body Piercing Mechanical Stud and Clasp Ear Piercing <br />Branding 0 Permanent Cosmetics <br />II. REQUIRED REGISTRATION, PERMIT, OR NOTIFICATION FEES: Check all that apply. <br />irSirAnnual Body Art Practitioner Registration 3 Mechanical Stud and Clasp Ear Piercing Notification <br />2 Annual Body Art Facility Permit <br />III. APPLICANT INFORMATION: <br />V <br />1 <br />Phone: <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />