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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# PT0028880 for Record ID# PR0547986 <br /> Valid From 7/1/2023 To 6/30/2024 <br /> PERMITS TO OPERATE are NOT TRANSFERABLE <br /> and may be SUSPENDED or REVOKED for cause. <br /> PERMIT(s)Valid only for: ALEMAN,JOSE JR <br /> DBA: OLD VINE TATTOO <br /> THIS FORM MUST BE DISPLAYED CONSPICUOUSLY ON THE PREMISES <br /> Regulated Facility: OLD VINE TATTOO (ALEMAN,JOSE JR) Facility ID FA0027366 <br /> 521 W KETTLEMAN LN Account ID AR0052704 <br /> LODI CA 95240 issued 5/25/2023 <br /> Billing Address: ATTN : ALEMAN, JOSE JR <br /> OLD VINE TATTOO <br /> 149 PANAMA ST <br /> SAN FRANCISCO CA 94132 <br /> 7027.rpt End of Report <br />