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,gyp Ui'!y Date(MM/DD/YY) l�1 7-1 z <br /> . Body Art Inspection Report <br /> County of San Joaquin County,Environmental Health Department <br /> Permit Number <br /> 1868 E.Hazelton Ave.,Stockton CA 95205 <br /> t: (209)468-3420 www.sigov.org/ehd Q <br /> Permit Type <br /> Facility Name Address City <br /> � Zip Code CT <br /> L � 1 ! iVz Ave-As) K6,/1 <br /> 'rr:5L-Acri <br /> PermitlRegistration Holder Name Permit Exp.Date Total Time Inspection Type <br /> =-v-1a <br /> 4" ir� <br /> 35. Plan Review ❑ 777 <br /> 36 Permits Obtained&Available ❑ <br /> 37. Impoundment <br /> ro <br /> 38. Hearing Scheduled ❑ <br /> 39. Closure' p <br /> Items marked with an asterisk'may also havespecific requirements for temporary events <br /> REt3# PRACTITIONEWARTIST NAME, _ _. • ... .. .r tR�G� . M� rPRAGT[CIONERIARTISTNAMEw^ ti,= �. <br /> e fypp� <br /> 's r ,.,,il." Q CORRECTWACTfONS"xas't.' ", _ ,� "x 4 � .. y -;'s�, °4g a'. <br /> 6 + <br /> s c) <br /> r <br /> 4„-k- <br /> -)- <br /> .e r1 <br /> e - -v►. tet. <br /> � l DnIMZi <br /> 1LI. <br /> C <br /> Received b (Print): Received by(Signature): Phone: <br /> Specialist(Print): Specialist(Signature): Phone: <br /> ❑ This report is an Official Notice of Violation.Corrections must be completed in the time specified. <br /> A reinspection fee may be charged if violations noted on this report are not corrected by the reinspection date. Reinspection Date(on or about) <br /> Page of l <br />