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,o�q�•"moo 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 f°7 DO��6� 7 <br /> (209)468-3420 www.sigov.orci/ehd <br /> a� Permit Type —i <br /> Facility Name Address City ,/l _ Zip Code CT <br /> r _ G ICA, k7 %Ai�7-)0 '423 C- tl-VtPr l/�- �t (�iZJYI C1'S�d— ISQ, 1 rFJIw ,... w1�1 <br /> Permit/Registration Holder Name Permit Exp.Date Total Time Inspection type <br /> 7 1-��a.. � \/+Z�Y M� Gc30-!�-� C_o�►t fit,i � <br /> 35. Plan Review ❑ <br /> 36 Permits Obtained&Available* 1337. Impoundment El <br /> 38. Hearing Scheduled ❑ <br /> 39. Closure* ❑ <br /> Items marked with an asterisk*may also have specific requirements for temporary events <br /> `REG. .QRACTR RI iRTIS NAME'""` ,h "REt3��.',��r.�i PRACTITIONER) RTISTNAIME <br /> ee <br /> VI!, <br /> 2c 1�0 <br /> 3. o� <br /> �t Z JC7 <br /> 4—^4U <br /> S S l►ti r�- 6Y� <br /> Received by(Print): Received by(Signature): Phone: <br /> Specialist(Print): Specialist(Signature): Phone: <br /> F1This 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 /> Paae.2 of <br />