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tDate(MM/DD/YY) 11 ,) –17 <br /> Body Art Inspection Report <br /> County of San Joaquin County,Environmental Health Department Permit Number <br /> 1868 E.Hazelton Ave.,Stockton CA 95205 <br /> (209)468-3420 www.sigov.org/ehd <br /> v Permit Type <br /> Facility Name Address city Zip Code CT <br /> A v`s` (.,'-1 e.: i y, - ✓i VN <br /> Permit/Registration <br /> 66 Holder Name Permit Exp.Date Total Time Inspecfi Type <br /> T 1'VYL47 <br /> Si/l �2ti I <br /> 737. <br /> Plan Review 7777 <br /> Permits Obtained&Available* <br /> Impoundment p <br /> 38. Hearing Scheduled ❑ <br /> 39. Closure* ❑ <br /> Items marked with an asterisk*may also havespecific requirements for temporary events <br /> F <br /> REG# pRACTITIQ�iERfARTIST NAME REG# PRACTITIONERIARTISi NAME.. f <br /> C►RSERVATtQN8Akft6RREcTwAc'rws <br /> c— Int ✓ <br /> GG – <br /> 1Qz✓�r T <br /> 4&-,t L O <br /> —Mv <br /> 1 r►ti <br /> l I lQl 1 3 <br /> tl ( Otzeu <br /> q 30 <br /> Received b Print); c. J Received b (Signature): Phone: <br /> Specialist (Print): Y� Za e-4,41101LeSpecialist(Signature): Anat Phone: l <br /> F1This report is an Official Notice of Violation.Corrections must be completed in the time specifi <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 Z of <br />