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Body Art Inspection Report Date(MM/DD/YY) <br /> y County of San Joaquin County,Environmental Health Department <br /> 1868 E.Hazelton Ave.,Stockton CA 95205 Permit Number <br /> (209)468-3420 www.sIaov.org/ehd <br /> Permit Type <br /> Facility Name Address <br /> // City Zip Code CT <br /> 1M <br /> J :Laid soc& i�Z Ay-- -X44 DW4e16;j,A1n <br /> Permit/Registration Holder Name Permit Exp.Date Total Time Inspection <br /> Lex r 3c`� r 3 �L��i t csv/in2 <br /> 35. Plan Review ❑ <br /> 36 Permits Obtained&Available* ❑ <br /> 37. Impoundment ❑ <br /> 38. Hearing Scheduled ❑ <br /> 39. Closure' ❑ <br /> Items marked with an asterisk'mayalso hivespecific requirements for temporary events <br /> ,r" e.�-.� '.�,.� "`,c - 5'3�"3r�.�fi4 .� "�+s' .,,.. ", ,. ," s',{4.'t.&P.k�-::�e'#'3 .�`.f-�� ''�'� �"',``' �s�'Y�,�[�' ✓ '" �,a'= <br /> PWTl�to �RII RT191'I00 we " <br /> 4 <br /> ' SIMMS <br /> -01 <br /> l 1 <br /> e <br /> r <br /> v <br /> res kn�f, <br /> IF <br /> 7 EA <br /> ,l <br /> z <br /> rn 671t. <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 gof <br />