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EnvironmentalHealth
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EHD Program Facility Records by Street Name
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4100 – Safe Body Art
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PR0547890
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Entry Properties
Last modified
8/1/2023 2:25:29 PM
Creation date
7/26/2023 12:02:25 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4100 – Safe Body Art
File Section
BILLING/PERMITS
RECORD_ID
PR0547890
PE
4120
FACILITY_ID
FA0027298
FACILITY_NAME
REVIVE ME (MELENDEZ SERRANO, LUIS)
STREET_NUMBER
445
Direction
W
STREET_NAME
BEVERLY
STREET_TYPE
PL
City
TRACY
Zip
95376
CURRENT_STATUS
01
SITE_LOCATION
445 W BEVERLY PL
P_LOCATION
03
QC Status
Approved
Scanner
SJGOV\cfield
Tags
EHD - Public
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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 I{ang, RMRS., Director <br />ENVIRONMENTAL HEALTH <br />PERMIT TO OPERATE - PE 4120 - BODYART FACILITY -SINGLE USE <br />Permit ID # PT0028798 for Record ID # PR0547890 <br />Valid From 8/5/2022 To 6/30/2023 <br />PERMTTS TO OPERATE aze NOT TRANSFERABLE <br />and maybe SUSPENDED or REVOKED for cause. <br />PERMIT(s) Valid only for: MELENDEZ SERRANO, LUIS <br />DBA: REVIVE ME <br />THIS FORIN MUST BE DISPLAYED CONSPICUOUSLY ON THE PREMISES <br />Regulated Facility: REVIVE ME (MELENDEZ SERRANO, LUIS) Facility <br />ID FA0027298 <br />445 W BEVERLY PL Account ID gR0052481 <br />TRACY CA 95376 sued 8/11/2022 <br />Billing Address: ATTN : MELENDEZ SERRANO, LUIS <br />REVIVE ME <br />2725 PAVILION PKUVI APT 9309 <br />TRACY CA 95304 <br />Ie27.rpt End of Report <br />
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