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• <br />E,n Date(MM/DD/YY)*U.!Body Art Inspection Report County of San Joaquin County, Environmental Health Department `r` yD <br />1868 E. Hazelton Ave., Stockton CA 95205 Permit Number L' <br />(209) 468-3420 wwiv.sigov.om1ehd12-1 <br />Permit Type 4-11 <br />Facility Name i [ Address City Zip Code CT <br />61 A tl A 1vt fL�% �`'� ZZ I� irtl�iGi �eA'4 4 6 y K� -5c�i� -AC Y� <br />Permit(Registration Holder Name Pe it Exp. Date Total Time Inspection Type <br />AA ��� � mei n 7s 6 zoo i3 )ze' iW <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 />p <br />Items marked with an asterisk ` may also have specific reauirements for <br />REG # .. - . : <br />PRACTITIONERIARTIST NAME <br />REG # PRACTITIONERIARTIST NAME <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 />Pauea of LC <br />