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0 <br /> Date(MM/DD/YY)Body Art Inspection Report <br /> y County or San Joaquin County,Environmental Health Department <br /> Q: + Permit Number <br /> �.n. :< 1868 E.Hazelton Ave.,Stockton CA 95205 <br /> . (209)468-3420 www.sioov.org/ehd <br /> Permit Type �� <br /> Facility Name Address c n`mss City �, J Zip CCT <br /> `'ode cif Q <br /> Permithkegistrafion Holder Name Permit Exp.Date Total Time Inspection Type <br /> rev i 1 WY�✓Lf fY�" 30-1 <br /> 35. Plan Review ❑ <br /> 36 Permits Obtained&Available* ❑ <br /> 37. Impoundment ❑ <br /> 38. Hearing Scheduled O <br /> 39. Closure* p <br /> Items marked with an asterisk*may also haves specific requirements for temporary events <br /> REG# PRACTITIONERlARTIST NAME REG#, PRACTITIONERIARTIST NAME D <br /> INN <br /> �yrVATIONSANfl CORRECTIVE ACTIONS .. w t . f ! Y'ar4 , + ,,s <br /> 1 <br /> 1q% i . <br /> i> 1 ej.Y"tj re- N�e-rz g e c\, - m, yu m . <br /> s I4L 117 �— <br /> '� 1 Ce' — <br /> 1,l C r S C311 a j?4 e <br /> Received by(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 /> PaaS <br /> e of q <br />