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o' Body Art Inspection Report Date(MM/DD/Y17 <br /> o` <br /> County of San Joaquin County,Environmental Health Department <br /> 1868 E.Hazelton Ave.,Stockton CA 95205 Permit Number <br /> (209)468-3420 v�nvd.siaov.ora/ehd <br /> Permit Type <br /> Faali Name Address City Zip Code CT <br /> �a e"'OrA- Sal( s/ DQEAO. 1T)nUj.14unvrncf Ln_ 94-o knn `SWO S&n Jogyl, , <br /> Permit/Registration Holder Name Permit Exp.Date Total Time Inspection Type <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Received by(Print): Received by(Signature): Phone: Q /15!wK/0 <br /> - <br /> !, �y- <br /> Specialist(Print): tom? )Il CS Specialist(Signature): -4� Phone:C:)M "Ll0 9-3 <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 /> Page of3 <br />