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Body Art Inspection Report Date(MMIDD/YY) <br /> County of San Joaquin County,Environmental Health Department <br /> <, 1868 E.Hazelton Ave.,Stockton CA 95205 Permit Number <br /> /1 (209)468-3420 www.siaov.org/ehd � <br /> Permit Type <br /> 4�j`pJia <br /> Facility Name Address City Zip Code CT <br /> 6 M- +7Z& 6:;3 1 a c�)z /4v?--- LW-Kfn)n �sv2y'7 <br /> Permit/Registration Holder Name Permit Exp.Date Total Time Inspection Type <br /> 0BSER4A710NSANDCORRECTIVEACTIONS <br /> G <br /> rcb3 '-kLI _ E <br /> o <br /> 711 1 <br /> to <br /> Received b (Print): k1 a Received b (Si nature): Phone: <br /> Specialist (Print: Specialist(Sign ture): Phone: -Lie' ? <br /> F1This report is an Official Notice of Violation.Corrections must be completed in the time s e red. <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 /> PAGag of-3 <br />