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am <br />k, -- <br />Date (MM/DD/YY) <br />Permit Number 1l <br />Permit Type vlI Lb <br />� <br />Zip Code CT <br />h S3� b S h, �fv Lz "1 ' <br />Total Time Inspection T <br />c 1- L' <br />LL (--`j z <br />"41"v\ rv` 1?' Iry ANAef I—)V�'r ai f )\ r!� An �� Ai � � l � i r i i C 'r+�i.- ,��1� ✓ <br />Received by (Print): do �y� �� /' 1 k�l rS Received by (Signature): ""�—� Phorytt: 20f- 06 .3'N/J <br />F1This 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 />Paged of y <br />0 <br />Body Art Inspection Report <br />2 y <br />County of San Joaquin County, Environmental Health Department <br />1868 E. Hazelton Ave., Stockton CA 95205 <br />(209) 468-3420 www.sioov.org/ehd <br />FacilityN� e <br />I t , a s <br />City <br />s1, 7rz <br />1Il/�W <br />1jJ�i Gita �, ��,•r�n���l <br />Permit/Registration Holder Name <br />Permit Exp. <br />L <br />35. <br />Plan Review <br />❑ <br />36 <br />Permits Obtained & Available ` <br />❑ <br />37. <br />Impoundment <br />❑ <br />38. <br />Hearing Scheduled <br />❑ <br />39. <br />Closure' <br />❑ <br />Items marked with an asterisk ` may also have specific requirements for temporary <br />events <br />am <br />k, -- <br />Date (MM/DD/YY) <br />Permit Number 1l <br />Permit Type vlI Lb <br />� <br />Zip Code CT <br />h S3� b S h, �fv Lz "1 ' <br />Total Time Inspection T <br />c 1- L' <br />LL (--`j z <br />"41"v\ rv` 1?' Iry ANAef I—)V�'r ai f )\ r!� An �� Ai � � l � i r i i C 'r+�i.- ,��1� ✓ <br />Received by (Print): do �y� �� /' 1 k�l rS Received by (Signature): ""�—� Phorytt: 20f- 06 .3'N/J <br />F1This 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 />Paged of y <br />