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SAN JOAQUIN COUNTY ENVIR MENTAL HEALTH DEPARTMENT <br />1868 E. Hazelton Ave • Stockton, CA 95205-6232 • Phone (209) 468-3420 <br />Jaspt Kang, R.E.H.S., Director <br />ENVIRONMENTAL HEALTH <br />PERMIT TO OPERATE - PE 4120 - BODY ART FACILITY SINGLE USE <br />Permit ID # PT0028798 for Record ID # PR0547890 <br />Valid From 7/1/2023 To 6/30/2024 <br />PERMITS TO OPEIZATE are NOT TRANSFERABLE <br />and maybe SUSPENDED or REVOKED for cause. <br />—11111111111111111111illillillillillillilliillillillillillillilliillillillillilillillillillillillilliillillilI 1111111111111111111111111111111111111111111111111111 <br />PERMIT(s) Valid only for: MELENDEZ SERRANO, LUIS <br />DBA: REVIVE ME <br />THIS FORM MUST BE DISPLAXED CONSPICUOUSLX ON THE PREMISES <br />FZegu�ated Facility: REVIVE ME (MELENDEZ SERRANO, LUIS) <br />445 W BEVERLY PL <br />TRACY UA 95376 <br />Bill <br />ingAddress: ATTN : MELENDEZ SERRANO, LUIS <br />REVIVE ME <br />16460 HILGARD DRIVE <br />LATHROP CA 95330-8114 <br />7027.rp1 <br />Facility ID FA0027298 <br />,4ccount ID AR0052481 <br />Issued 5/25/2023 <br />End of Reporl <br />