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o�,N_ Date(MM/DD/YY) I o W j3 <br /> a Body Art Inspection Report <br /> County of San Joaquin County,Environmental Health Department g)S <br /> 1868 E.Hazelton Ave.,Stockton CA 95205 Permit Number <br /> 1: (209)468-3420 v✓\vw.sigov.org/ehd (,I'u3 <br /> Permit Type <br /> \eq C'I <br /> 19; P <br /> Facility Name Address City Zip Code CT <br /> Qr�c�woo•AS AIu (�¢s;�,ncr .vs 1'1'�® w �lwn. v�Ln �'atic,�on gsaO-) SCA') ,lou�1 <br /> Permit/Registration Holder Name Permit Exp.Date Total Time Inspection Type <br /> EtcuS�: Lw ��,t�ial f�a�ly Ar+ <br /> ;ENF_ . C.ME TRA GPRO R .�. r� <br /> 35. Plan Review ❑ <br /> 36 Permits Obtained&Available* ❑ <br /> 37. Impoundment ❑ <br /> 38. Hearing Scheduled ❑ <br /> 39. Closure* ❑ <br /> Items marked Mth an asteriskmay also havespecific requirements for temporary events <br /> , <br /> REG# PRACTITIONEWARTIST NAME REG# PRACTITIONERIARTIST NAME <br /> OBSERVATIONSANDCORRECTIVE ACTIONS <br /> L f 016()r' io rl <br /> 1113tt C3 - ) CADD fleaNgtr <br /> m (h WA11 m n d' oue S <br /> 9 15 r �une a 0►1 a m l <br /> A," 6�- o^ U 1g, kle if) <br /> Bio ro., <br /> s <br /> 04; t a 10 of 1A f.2sd s - Q,; <br /> r <br /> l,�. nc IVA <br /> Co <br /> ca <br /> `cam <br /> Received by(Print)' se f— P Received by(Signature): Phone: <br /> Specialist(Print)' Specialist(Signature): Phone: <br /> ❑ This 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 of 3 <br />