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f <br />40 <br />s� <br />,o �`'•"`' o Body Art Inspection Report Date (MM/DD/YY) <br />y County of San Joaquin County, Environmental Health Department <br />w 1868 E. Hazelton Ave., Stockton CA 95205 Permit Number <br />(209) 468-3420 www.sioov.ora/ehd <br />P • Permit Type <br />/FO <br />a` .0 <br />Facility Name Address City Zip Code CT <br />Permit/Registration Holder Name Permit Exp. Date Total Time Inspection Type <br />Phone: <br />Specialist (Print): Specialist (Signature): 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 3 ofpt <br />