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Environmental Health - Public
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EHD Program Facility Records by Street Name
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4100 – Safe Body Art
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PR0539655
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Last modified
7/26/2023 10:01:00 AM
Creation date
4/4/2023 8:24:52 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4100 – Safe Body Art
File Section
BILLING/PERMITS
RECORD_ID
PR0539655
PE
4120
FACILITY_ID
FA0022695
FACILITY_NAME
DEATH RAY TATTOO (GOFF, IAN)
STREET_NUMBER
181
Direction
S
STREET_NAME
UNION
STREET_TYPE
RD
City
MANTECA
Zip
95337
APN
22208027
CURRENT_STATUS
01
SITE_LOCATION
181 S UNION RD STE 105
P_LOCATION
04
P_DISTRICT
005
QC Status
Approved
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SJGOV\cfield
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EHD - Public
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l { <br /> SAN JOAQUINOUNTY ENVIRONMENTAL HEALT*PARTMENT <br /> 1868 E.Hazelton Ave. •Stockton,CA 95205-6232 •Phone(209)468-3420 <br /> Linda Tarkatte,R.E.H.S.,Director <br /> ENVIRONMENTAL HEALTH <br /> PERMIT TO OPERATE - 4110-BODY ART PRACTITIONER REGISTRATION <br /> Permit ID#PT0024397 for Record ID#PR0539656 <br /> Valid From 9/19/2019 To 6130/2020 <br /> PERMITS TO OPERATE are NOT TRANSFERABLE <br /> and may be SUSPENDED or REVOKED for cause. <br /> PERMIT(s)Valid only for: MILLS,KIMBERLEY <br /> DBA: ONE SIXTEEN TATTOO <br /> THIS FORM MUST BE DISPLAYED CONSPICUOUSLY ON THE PREMISES <br /> Regulated Facility: ONE SIXTEEN TATTOO LLC (MILLS, KIMBERI Facility ID FA0022695 <br /> 181 S UNION RD# 105 Account ID AR0041562 <br /> MANTECA CA 95337 issued 9/2012019 <br /> Billing Address: ATTN : MILLS, KIMBERLEY <br /> ONE SIXTEEN TATTOO LLC <br /> 1232 YORKTOWN LN <br /> MANTECA CA 95336 <br /> 7ozz.rpt <br />
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