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Body Art Inspection Report <br />County of San Joaquin County, Environmental Health Department <br />1868 E. Hazelton Ave., Stockton CA 95205 <br />�.. (209) 468-3420 www.sigoy.orq/ehd <br />Date (MM/DD/YY) b-5-121 <br />Permit Number SKcr"'F, <br />Permit Type 411 y3 <br />Facility Name Address City Zip Code CT <br />'Teke.;vSfCr�rLS-6-A. X (A S. kiL c C : QAC -vr"4 . , Sa j j 3c"g4 4, / h <br />Permit/Registration Holder Name Permit Exp. Date Total Time Inspection Type <br />L 1 VN I& 1 t'Tw -T-11 /`, i- ', Y4yo , 112% /7 t_ <br />35. <br />Plan Review <br />❑ <br />36 <br />Permits Obtained & Available * <br />❑ <br />37. <br />Impoundment <br />❑ <br />38. <br />Hearing Scheduled <br />❑ <br />39. <br />Closure ` <br />❑ <br />with an asterisk' may also have <br />*'REG# CTITIONERIARTISTNi4ME :,.. <br />PRA <br />�. - A KEG #; <br />PR' CTITION RIARTISTNAME";, <br />a . OBSERVATIONS ANI);CORRECT ACTIONS, � ,:. ,t . , , y , e. _ K. <br />Alit aieois.L. ;'fit )-+ ft <br />I�Cn <br />i <br />Pec N � �- --IOLA tz-�j all 11364f <br />lYl• ' h 1 <br />(� i � A <br />�. <br />ivy <br />-Ahe iv -r P, <br />S.92, LAA hilaW 62r - <br />Received by (Print): I Received by (Signature : Phone: <br />Specialist (Print): j41�tn it �t Specialist (Signature): Phone:_ -74? j- -/a--,5-7 -Z, <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 />Page Z— of <br />