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a¢ " Body Art Inspection Report Date(MM/DD/YY) <br /> y County of San Joaquin County,Environmental Health Department <br /> f E 1868 E.Hazelton Ave.,Stockton CA 95205 Permit Number <br /> ix ' <br /> • (209)468-3420 ,vwwsioov.orgfehd �r <br /> o Permit Type <br /> a=o a <br /> Facility Name Address City kip Code CT <br /> Permit/Registration Holder Name Permit Exp.Date Total Time Inspection Type <br /> 35. Plan Review ❑ <br /> 36 Permits Obtained&Available ❑ <br /> 37. Impoundment ❑ <br /> 38. Hearing Scheduled p <br /> 39. Closure' ❑ <br /> Items marked with an asterisk*may also have speck requirements for temporary events <br /> REG# PRACTITIdNERIARTIST NAME REG# PRACTITIONERIARTIST NAME <br /> Z. <br /> 013SERMATIONSAM ddRRECTIVE ACTIONS <br /> i ss d S <br /> A <br /> Received b Print: S rn� w Received by(Signature): Phone: <br /> S ecialist(Print): CGLt.II.a/�1 Specialist(Signature): Tom+ - 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_,of_ <br />