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0 0 <br /> o a'tN�o Body Art Inspection Report Date(MM/DD/YY) 5"S-!3 <br /> i y County of San Joaquin County,Environmental Health Department r— <br /> Permit Number <br /> 1868 E.Hazelton Ave.,Stockton CA 95205 ICJ R <br /> (209)468-3420 www.siaov.oro/ehd <br /> ` P Permit Type /— <br /> �3Fva <br /> Facility Name Address City Zip Code CT <br /> 14W-r� Lut�btu -7Al _NO4,04- 611C 4- 4-�" ' �:s �0 KAzi AI-w1j L! h <br /> Permit/Registration Holder Name Permit Exp.Date Total Time Inspection <br /> 35. Pian Review <br /> 36 Permits Obtained&Available' ❑ <br /> 37. Impoundment ❑ 17 <br /> 38. Hearing Scheduled p <br /> 39. Closure' ❑ <br /> Items marked with an asterisk'may also haves eoft requirements for temporary events <br /> PRAGTRIONERfARTIST,LAAMEr <br /> REG VPRACTITIONERTARTISi'NAME . <br /> ` � °.08SERVATIONS`aN�CORRECTNEACTIONS,� ` � � . <br /> Yq <br /> l <br /> k 1A 4& d2123fr <br /> nA�'—Q evv 2 P -,-t 4� <br /> l <br /> .See- n <br /> Received b Print): Received b (Signature): 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 maybe charged if violations noted on this report are not corrected by the reinspection date. Reinspection Date(on or about) <br /> Paqe"goM <br />