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a u H R rt Date (MM/DD/YY) / i7 - 16— / Z <br />�o Bady Art Inspection epo <br />ry County of San Joaquin County, Environmental Health Department <br />1 1868 E. Hazelton Ave., Stockton CA 95205 Permit Number <br />�. (209) 468-3420 www.sioov.oro/ehd <br />Permit Type <br />Facility Name Address city Zip Code CT <br />�s cc t g.` l'c �i� a �% <br />Permit/Re rstration Holder Name Permit Exp. Date Total Ti a Inspection Type <br />35. <br />Plan Review <br />❑ <br />V _ <br />36 Permits Obtained & Available *i <br />fl >i I& u MYA1XIMIR <br />�L <br />i r I <br />di <br />37. Impoundment <br />❑ <br />1 � i► <br />38. Hearing Scheduled <br />❑ <br />39. Closure * <br />❑ <br />Items marked Mth an asterisk' may also havespecific requirements for temporary events <br />REG# PRACTITiONERIARTISi AME REG# PRACTRIONERIARTIST.NAME <br />Received by (Print): Received by (Signature)' Phone: <br />F1This report is an Official Notice of Violation. Corrections must be completed in the#imVsp�fied. <br />A reinspection fee may be charged if violations noted on this report are not corrected by t e reinspection date. <br />Page Q of 6 <br />Reinspection Date (on or about) <br />OBSERVATIONS <br />V _ <br />r ♦ l I� <br />fl >i I& u MYA1XIMIR <br />�L <br />i r I <br />di <br />� I1i 1 � I. � <br />7_ � <br />1 � i► <br />MW <br />�� fu <br />ALJ � .1 <br />� ✓ % � <br />� <br />� ♦ � 1 ! i t <br />� rte, ■ <br />li "ISM[ <br />- <br />Received by (Print): Received by (Signature)' Phone: <br />F1This report is an Official Notice of Violation. Corrections must be completed in the#imVsp�fied. <br />A reinspection fee may be charged if violations noted on this report are not corrected by t e reinspection date. <br />Page Q of 6 <br />Reinspection Date (on or about) <br />