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Qu,N Date(MM/DD/YY) 3�C <br /> fo .. off Body Art Inspection Report <br /> County of San Joaquin County,Environmental Health Department ) ' <br /> 1868 E.Hazelton Ave.,Stockton CA 95205 Permit Number /l 7 <br /> :•/ (209)468-3420 www.sigov.or /q ehd <br /> / Permit Type '�//C> <br /> Facility Name Address City Zip Code CT <br /> rn -141, &.4- } h V M 6M�y acct Pi l( AV7- S E�Y77Y1 Lei <br /> PermiUR gistration Holder Name Permit Exp.Date Total Time Inspection Type <br /> err Tvr n -Er�er�- t <br /> 35. Plan Review ❑ <br /> 36 Permits Obtained&Available* ❑ <br /> 37. Impoundment ❑ <br /> 38. Hearing Scheduled ❑ <br /> 39. Closure'` ❑ <br /> Items marked with an asterisk*may also havespecific requirements fortemporary events <br /> REG# PRACTITIONERIARTIST NAME REG# PRACTITIONERIARTIST NAME <br /> {2f3S£RVATIt`tSA �CQRItECT141RAttT�OfISYA � % <br /> X411 1 ken, o yK io Le-fr <br /> -# G 3 i 5 ju —wt, <br /> tvvm <br /> VI 01 <br /> e <br /> S (1(l �, i� ►Z � r-Yt <br /> o fD S I G l r <br /> f <br /> G I �?C <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 /> r <br /> Page�.of y <br />