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oqu`N Body Art Inspection Report Date(MM/DD/YY) <br /> County of San Joaquin County,Environmental Health Department <br /> 1868 E.Hazelton Ave.,Stockton CA 95205 Permit Number <br /> 1._ (209)468-3420 www.siciov.org/ehd <br /> \\ Permit Type <br /> �a/FpR? <br /> Facility Name Address1 cityZip Code <br /> CAa,! t t7y \ '6 J-6 /V • V G'Y" <br /> �- JI V VI 7CT 11 <br /> Permit/Registration Holder Name Permit Exp.Date Total Time Inspection Type <br /> �u Yn— 46- &Vvr-�7 <br /> 35. Plan Review ❑ <br /> 36 Permits Obtained&Available* ❑ <br /> 37. Impoundment ❑ <br /> 38. Hearing Scheduled ❑ <br /> 39. Closure* ❑ <br /> Iterns marked with an asterisk*may also haves ecific r uiren-ents for temporary events <br /> REG# PRAGTITIONERfART15TNRME"IF „>. t . REG# PRACTITIONERIARTIST NAME <br /> VS1- <br /> 1 <br /> CIIk <br /> ,S f3 ra '/Z <br /> c <br /> dz <br /> G 01n, eoc.-Ac <br /> .� 1s <br /> r S <br /> Received by(Print); Received by(Signature): Phone: <br /> Specialist(Print): Specialist(Signature): Phone: <br /> ❑ This report is an Official Notice solation.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 AofJ <br />