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Date(MM/DD/YY) ShUl l�_ <br /> io Body Art Inspection Report <br /> ; � o2 County of San Joaquin County,Environmental Health Department <br /> la < 1868 E.Hazelton Ave.,Stockton CA 95205 Permit Number MJ <br /> (209)468-3420 www.siaov.org/ehd 1 �b,3 <br /> \� Permit Type '1 <br /> \lF�pR� <br /> Facility Name Address City Zip Code CT _ <br /> 140t a'`; 0 4,11E.. AQJLcidk �-(4��pti <br /> Permit/Registration Holder Name Permit Exp.Date Total Time Inspection Type 1 11 <br /> 5Uc� �TC1�� Fi 4o04v, A(k 'C1�1SK�T067�tin/ <br /> _ T INGPDEDr. . : .b $ �'" n�rx <br /> SOME'ANC A_ND"ENF_0_RCEMENT _,�p x r <br /> 35. Plan Review <br /> 36 Permits Obtained&Available* ❑ <br /> 3I__ Impoundment . _ _ _ ❑ <br /> 38. Hearing Scheduled <br /> 39. Closure ❑ <br /> Items marked with an asterisk`may also havespecific requirements for temporary events <br /> REG#, u PRACTITIONERIARTIST NAME REG# PRACTITIONERIARTIST NAME <br /> 088ERVATIONS'ANDCORRECTIVE ACTIONS , <br /> � D )1c. 3131W lnub,, r C 14 Rim,wim <br /> L ` 1 � <br /> Lbs 1 X11 . 7 .r 0411 o CJS i bt /N , ►1 — <br /> hid, Sid --oo, n <br /> Received by(Print): Se-�- P• Received by(Signature): Phone: <br /> Specialist(Print): Specialist(Signature): Phone: <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 /> Paged of3 <br />