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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 # PT0029319 for Record ID # PR0548552 <br />Valid From 7/6/2023 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: BAXTER, KOEDY <br />DBA: IN BLOOM TATTOO & PIERCING <br />THIS FORM MUST BE DISPLAYED CONSPICUOUSLY ON THE PREMISES <br />Regulated Facility: IN BLOOM TATTOO & PIERCING (BAXTER, KOEDY) <br />Facility ID FA0027757 <br />18 E ELEVENTH ST <br />Account ID AR0053868 <br />TRACY CA 95377 <br />Issued 7/11/2023 <br />Billing Address: ATTN : BAXTER, KOEDY <br />IN BLOOM TATTOO & PIERCING <br />1415 MONTAUBAN CT <br />TRACY CA 95304 <br />7027.rpt <br />End of Report <br />