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o <br /> o uDate MM/DD/YY) <br /> J - <br /> ��o .v o Body Art Inspection Report ( <br /> County of San Joaquin County,Environmental Health Department <br /> a Permit Number <br /> 1868 E.Hazelton Ave.,Stockton CA 95205 <br /> \_ (209)468-3420 wnvvr.siaov.orglehd Permit Type <br /> S�FLtR_ <br /> Facility Name Address City Zip Code CT <br /> v.�- Alt �1 -S, 69 40 t tom` �k-, 1-K 4 g537L. ':5' <br /> - <br /> PermittRegistration Holder Name Permit p.Date Total Time Inspection Typ <br /> p �C)An <br /> 737. Plan Review p <br /> Permits Obtained&Available' ❑ <br /> Impoundment ❑ <br /> 38. Hearing Scheduled p <br /> 39. Closure" I ❑ <br /> Items marked with an asterisk'may also havespecific requirements for temporary events <br /> REG# PRACTITIONERIARTIST NAME REG# PRACTITIONERIARTIST NAME777777 <br /> ' <br /> OBSMVATIONS;ANDCORRECTWEA0ildNs;,,. <br /> J <br /> t / -NYt C�3LNI +� <br /> % l 11 LIS ' -ln,& L L <br /> G <br /> eLA c.) cJ <br /> l <br /> J- <br /> L� S <br /> 1Z 77b r, <br /> Received b (Print): Received by(Signature): Phone: <br /> Specialist(Print): 1 Specialist(Signature): Phone:_-Aj;r7{f % "7 <br /> ❑ This report is an Official Notice of Violation.Corrections must be completed in the time <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 /> Paae„2 of <br />