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,o o Body Art Inspection Report <br />y County of San Joaquin County, Environmental Health Department <br />1868 E. Hazelton Ave., Stockton CA 95205 <br />(209) 468-3420 www.sioov.or !q ehd <br />`P <br />Facility Name Address city Zip Code <br />Et a SIL L 12-Ve- 01"A qS <br />P nnit[Registration Holder Name Permit Exp. Date Total Time <br />0\C ✓ ✓ -ie ZIT <br />r73�5PIan Review ❑ <br />36 Permits Obtained & Available * ❑ <br />37. Impoundment ❑ <br />38. Hearing Scheduled ❑ <br />39. Closure * ❑ <br />Items marked with an asterisk' may also have specific requirements for temporary events <br />Date (MM/DD/YY) /V -t-7,13 <br />Permit Number J 6 OD E2-5 <br />Permit Type 4t to C) <br />CT <br />''7-I-n-spection Type <br />=f11V-�ZL (- <br />pRAC7lT10rlER1ARTIST NAME REG# PRACTIT ONE�%R ARTISN1lM� ., m. <br />OF <br />Received by (Print): Received by (Signature): Phone: <br />Specialist (Print): Specialist (Signature): Phone: <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 />Paqe -2-of 3 <br />� � . .moi <br />r_ � ► � 1_' .. <br />� <br />_. <br />LaIw • wi71 <br />L'1 <br />W-119- <br />_ , <br />• <br />,'r L �� r-iw <br />.r <br />i <br />Received by (Print): Received by (Signature): Phone: <br />Specialist (Print): Specialist (Signature): Phone: <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 />Paqe -2-of 3 <br />