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--- ...-, <br /> f/°''•,t co Body Art Inspection Report Date(MM/DD/YY) <br /> County of San Joaquin County,Environmental Health Department nn Syr �p <br /> Ia < 1868 E.Hazelton Ave.,Stockton CA 95205 Permit Number SQ'Wobls O <br /> (209)468-3420 www.sioov.ora/ehd u <br /> o� � Permit Type <br /> Pacili Name Address City Zi Code CT <br /> P c �✓-u�on/ kb,aticn �c�tS ���0�. 0timme,S Lam. �Sa:O'� SIV) JO*AJAI-N <br /> Permit/Registration Holder Name Permit Exp.Date Total Time Inspection Type <br /> ��0� �rtst, Sni�;al Qn�l Ari ConSu�'a},'.., <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> e— <br /> MIIALd A <br /> jlfArw)a3 <br /> F`(l U15� T <br /> ar �P�P �- Su .ten' n(,tQ,. all Sutuj <br /> 4, d T s Q) <br /> OM-1A f0f CA, Or <br /> Received b (Print): / Received by(Signature): Phone: <br /> t�tt <br /> Specialist(Print): Y'C�aJI G L p Specialist(Signature): Phone: ZO°� -31 /O <br /> F-1This 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 /> Page3 of3 <br />