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• 0 <br /> Body Art Inspection Report Date(MM/DD/YY) <br /> y County of San Joaquin County,Environmental Health Department Permit Number Prou i S—1aa <br /> 1� 1868 E.Hazelton Ave.,Stockton CA 95205 <br /> + : (209)468-3420 www.sigov.ora/ehd <br /> ��• Permit Type 'Lit:Q l- <br /> .tFvr <br /> Facility Name Address City Zip Code CT <br /> Uv <br /> Permit/Registration Holder Name Permit Exp.Date Total Time Inspection ype <br /> die-inj cciv-v-\ <br /> 35. Plan Review ❑ <br /> 36 Permits Obtained&Available` ❑ <br /> 37. Impoundment ❑ <br /> 38. Hearing Scheduled ❑ <br /> 39. Closure" ❑ <br /> Items marked with an asteriskmay also have specific requirements for temporaflf events <br /> 1s 6 $W v P <br /> IT 1=Rf�RT TIXMC' ° <.e .i *s .. ;.� 1tR G' <br /> PRACTGTI�tONF.WA1tT15TNAME ,�:.. .. ,s ,N <br /> ' 3 r Al" <br /> ` ♦ t y � ' sr :"�' +'ate` - <br /> ' Ik"sA [�RRECT AtfT�DNS v .,r ��. <br /> ve- zln. <br /> �go OV <br /> - 1 <br /> czyy6t' .S <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 /> 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.4f5 <br />