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s - <br /> Body Art Inspection Report Date(MMlDDIYY) ��I1 <br /> i County of San Joaquin County,Environmental Health Department <br /> Pen-nit Number ��W pn,�SUOAPZ <br /> 1868 E.Hazelton Ave.,Stockton CA 95205 <br /> 1r (209)468-3420 w+w+.sioov.orolehd <br /> Permit Type <br /> \'\Ivo Raj <br /> Facility Name Address City Zip Code CT <br /> Qr^ t���,d S�l�n ,•. �cs (ro U_IAIA4 n,el Ln, 364,K n q Sz07 94"N 'TO tib -� <br /> Permit/Registration Holder Name Permit Exp.Date Total Time Inspection Type <br /> Erna 5 �4� l.u, F;rial <br /> I ; <br /> xa.: OMQ_ANC AND.ENt4QRCEMENT: '. $., s �4.r;` � TRAI NGP,ROVD D <br /> RRI <br /> 35. Plan Review ❑ <br /> 36 Permits Obtained&Available* ❑ <br /> _— 37 Impoundment -- — — -❑ - - - <br /> 38. Hearing Scheduled ❑ <br /> 39. Closure' ❑ <br /> Items marked with an aslerisk`may also havespecific requirements for temporary events <br /> REG#. PRACTITIONERIARTIST NAME °REG# PRACTITIONERIARTIST NAME <br /> bStS�g �� sk; <br /> " 085ERVATIONVAND CORRECTIVE ACTIONS <br /> L(Wgki ocT 1 �I� J �ht 1n i <br /> n <br /> v9 'n r o <br /> C.P. <br /> Received by(Print): SQ e, P S Received by(Signature): Phone: <br /> Specialist(Print): Specialist(Signature): Phone: <br /> ❑ This report is an Oficial 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 3 <br />