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aptn Body Art Inspection Report Date(MM/DD/YY) y1 3 <br /> o� <br /> 2 y <br /> County of San Joaquin County,Environmental Health Department <br /> a Permit Number <br /> ..<, 1868 E.Hazelton Ave.,Stockton CA 95205 <br /> J (209)468-3420 www.sicclov.org/ehd <br /> Permit Type <br /> F cc) <br /> /^ <br /> Facility Name `` Address �] city Zip Code � CT <br /> C.�1lo.?�.]� �G+��GvT� lsfth'�?7 6� � /l� - �J-✓ZiG✓�T— V�-- y 17i����'S�,Zlf�c <br /> Permit/Registration Holder Name Permit Exp.Date Total Time Inspection Type <br /> OBSERVATIONSANIYCORRE�N <br /> Ca C `'1n <br /> • r <br /> 1 <br /> i l t <br /> S <br /> 1Ct C4 �S <br /> Y <br /> VL 0 <br /> 5 <br /> i <br /> Received b (Print): t Q Received b (Si nature): C4t."—Phone: - L <br /> Specialist Print: A k 5 Specialist(Signature): Z Phone: c3 t7 rI 3 <br /> F1This report is an Official Notice of Violation.Corrections must be completed in the . e ecif <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 /> Paae J of-S <br />