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San Joaquin County <br />q 1868 East Hazelton Avenue <br />Environmental Health Department Stockton, CA 9s2os <br />P CTel: (209) 468-3420 <br />Fax: (209) 464-0138 <br />BODY ART FACILITY AND PRACTITIONER REGISTRATION/ <br />MECHANICAL STUD AND CLASP EAR PIERCING NOTIFICATION <br />I. PROCEDURES TO BE PERFORMED: Check all that apply (see back for definitions) <br />Tattooing =Body Piercing =Mechanical Stud and Clasp Ear Piercing <br />Branding ffxpermanent Cosmetics <br />II. REQUIRED REGISTRATION, PERMIT, OR NOTIFICATION FEES: Check all that apply. <br />ittAnnual Body Art Practitioner Registration 3=Mechanical Stud and Clasp Ear Piercing Notification <br />2=Annual Body Art Facility Permit <br />III. APPLICA INFORMATION: <br />NAME: t r Phone: ! <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />