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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 E. Hazelton Ave • Stockton, CA 95205-6232 • Phone (209) 468-3420 <br />Jasjit Kang, R.E.H.S., Director <br />ENVIRONMENTAL HEALTH <br />PERMIT TO OPERATE - PE 4110 -BODY ART PRACTITIONER REGISTRATION <br />Permit ID # PT0027901 for Record ID # PR0546599 <br />Valid From 7/1/2021 To 6/30/2022 <br />PERMITS TO OPERATE aze NOT TRANSFERABLE <br />and maybe SUSPENDED or REVOKED for cause. <br />PERMIT(s) Valid only for: FLEMING, CARLY <br />DBA: CARLY FLEMING <br />THIS FORM <br />MUST BE DISPLAYED CONSPICUOUSLY ON THE PREMISES <br />Regulated Facility: LODI MICRO CLINIC (FLEMING, CARLY) Facility ID FA0026438 <br />755 S FAIRMONT ST Account ID AR0050301 <br />LODI, CA 95240 Issued 5/10/2021 <br />Bill <br />ing Address: ATTN : FLEMING, CARLY <br />LODI MICRO CLINIC <br />2081 SYLVAN WAY APT 608 <br />LODI, CA 95242 <br />combinedrpl I End of report <br />