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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�1Gi �eA'4 4 6 y K� --f-5c�/� -AC Y� <br /> Permit(Registration Holder Name Pe it Exp.Date Total Time Inspection Type <br /> fleA I - 6 Illi r3 Ae,i <br /> 35. Plan Review ❑ <br /> 36 Permits Obtained&Available* ❑ <br /> 37. Impoundment ❑ <br /> 38. Hearing Scheduled ❑ <br /> 39. Closure* 11 <br /> Items marked with an asterisk`may also havespecific requirements for temporary events <br /> REG#..-. : PRACTITIONERIARTIST NAME REG# PRACTITIONERIARTIST NAME <br /> OBSERVAT16NS AND CORRECTNEACTIONS <br /> c;47 26n G t aj <br /> Pa <br /> .l+ <br /> yy1 <br /> a �\ <br /> SSG C,c�Si u <br /> Received b (Print): Received by(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 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 />