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Permit[Registration Holder Name -IN r Permit Exp. Date Total Time Inspection Type <br />Received by (Print): Received by (Signature): Phone: <br />Specialist (Print): Specialist (Signature): Phone: <br />F1This report is an Official Notice of Violation. Corrections must be completed in the time specified. <br />d. <br />reinspection fee may be charged if violations noted on this report are not corrected by the reinspection date. <br />Paae 3 of <br />Reinspection Date (on or about) <br />0,-1� lIvDate <br />�o <br />y <br />Body Art Inspection Report <br />County San Joaquin County, Environmental Health Department <br />(MM/DD/YY) <br />t7 1v <br />of <br />Permit Number <br />,. <br />% <br />1868 E. Hazelton Ave.. Stockton CA 95205 <br />(209) 468-3420 www.sigov.org/ehd <br />Permit Type <br />E -/I <br />` <br />Facility Name <br />Address City <br />Zip Code CT <br />Permit[Registration Holder Name -IN r Permit Exp. Date Total Time Inspection Type <br />Received by (Print): Received by (Signature): Phone: <br />Specialist (Print): Specialist (Signature): Phone: <br />F1This report is an Official Notice of Violation. Corrections must be completed in the time specified. <br />d. <br />reinspection fee may be charged if violations noted on this report are not corrected by the reinspection date. <br />Paae 3 of <br />Reinspection Date (on or about) <br />