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/�• •• Body Art Inspection Report Date(MM/DDNY) <br /> � � 02 County of San Joaquin County,Environmental Health Department �_ _�( ���� <br /> 1868 E.Hazelton Ave.,Stockton CA 95205 <br /> Permit Number '&1Q'0 1 i <br /> 1. a (209)468-3420 %"wj.siaov.org/ehd (� 0 <br /> e �c <br /> Permit Type `_. t 3 <br /> \9i,IFORa , 4 <br /> Facility Name Address City Zip Code CT <br /> Permit/Registration Holder Name Permit Exp.Date Total Time Inspection Type <br /> 5llr�� Qavwn Zl„ii a I 116d Ari 6!,u 444iu- 4 <br /> AND.ENORCEMEhtT , s .TRAI NGRROVID D.r� . „ >� <-.• � ti� r. Y <br /> 35. Plan Review ❑ <br /> 36 Permits Obtained&Available ❑ <br /> - 37- Impoundment --- -- <br /> 38. Nearing Scheduled ❑ <br /> 39. Closure" ❑ <br /> Items marked with an asterisk`My also havespecific requirements for temporary events <br /> REG# PRACTITIONERIARTIST NAME REG# PRACTITIONERIARTIST NAME <br /> SOBSERVATIONS`ANDCORRECTIVEACTIONS <br /> c t�uJ^ n o <br /> n EAS c 3-PCP <br /> S V%b K,, E tA -r1 s , t An <br /> owr <br /> 3 rAnw f �� e. m It 1 <br /> r <br /> ECL"\Pje' ]�'\4 u! i o f lit J <br /> Lb1 0�� 1 p►�i e. N <br /> S ^ Lb 4 k G VA 3 vc, 3 <br /> r <br /> Lb ' e- <br /> 0& \44- c-01 -LAIC- In 1� 1� <br /> Received by(Print): ��� {' ,� 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 /> F1 <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 /> Pages of3 <br />