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�'P°''IN• �o Body Art Inspection Report Date(MM/DD/YY) <br /> County of San Joaquin County,Environmental Health Department <br /> w •� Permit Number <br /> 1868 E.Hazelton Ave.,Stockton CA 95205 <br /> rT47D�a b� <br /> (209)468-3420 www.sigov.org/ehd <br /> :rq`oJa�� <br /> Permit Type <br /> Facility Name Address city Zip Code CT <br /> T,i,z z ✓7�lw,/ Avc_ Lm& (T5a02 -Save , 1 <br /> ��1 <br /> PermittRegistration Holder Name Permit Exp.Date Total Time inspection Type <br /> rte- <br /> La.,r� <br /> .yNS ,. r. NEAs,tse 6 1 <br /> OBSERVATIOANDCORRECTCTIONS ,� • -- '_ <br /> CC CC <br /> i circ <br /> -� �- <br /> w <br /> i / 5 <br /> C <br /> Y1 �b1 C in <br /> 7 -Av G <br /> Z e- 1�Z <br /> Received b (Print): v`C�rG� mac._ Received by(Sign atu re: Phone:Z°Q <br /> Specialist (Print* J Specialist Si nature: Phone: 7 <br /> r] This report is an Official Notice of Violation.Corrections must be completed in the time pecifi <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 3 of3 <br />