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q I •'c Body Art Inspection Report Date(MM/DD/YY) "7 -1 J <br /> y County of San Joaquin County,Environmental Health Department <br /> 1868 E.Hazelton Ave.,Stockton CA 95205 Permit Number °To �i�fj <br /> (209)468-3420 www.sigov.org/ehd <br /> Permit Type <br /> Facility Name Address City Zip Code CT <br /> .n31t�r�7�? <br /> by,-s- /�, �'5�37 � tS, �xtr� r•c �,.� <br /> Perm it/Registration Holder Name Permit Exp.Date Total Time Inspection Type U <br /> -11 <br /> Oi3SER1%ATIONS`AND CORREC�TNEi4CTONS � " <br /> �-er <br /> i <br /> t <br /> V I'All / <br /> - k <br /> a <br /> k <br /> S 1 <br /> Z <br /> L <br /> �- <br /> lM0 JWUrh <br /> / <br /> c>n vim <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 /> Paaeq of -5- <br />