HomeMy WebLinkAboutTimothy Bartles II Permit 610113 08 02 11 SC.pdf
North Carolina Department of Environment and Natural Resources Division of Environmental Health TATTOOING PERMIT Facility ID Tattoo Artist Permission is hereby granted to to engage in
tattooing as defined in G.S. 130A-283 at Place of Practice County *Date Signed Division of Environmental Health EHS I.D.# Permit is valid until: *Expiration Date Agent City ST Zip Address
Please use U P P E R C A S E B L O C K letters when filling in items with boxes ////Old Facility ID (required if Transitional) Water Supply: Waste Water System: Terrority #: Existing
Facility? Time In: Time Out: Total Time: : am pm am pm : T i m o t h y B a r t l e s I I T a t t o o L a b o r a t o r y 2 0 1 8 6 1 0 1 1 3 1-1 -Community 1-1 -Community 01 1 7 5 2
S t a r t o w n R d H i c k o r y N C 2 8 6 0 2 Catawba 0 8 0 2 2 0 1 2 0 8 0 2 2 0 1 1 1711 -Carpenter, Scott 0 4 0 0 0 4 4 4 44 minutes
Tattoo Permit State Environmental Health Director MPH State Health Director MD Environmental Health Specialist By North Carolina Department of Environment and Natural Resources Division
of Environmental Health Permission is hereby granted to to engage in tattooing as defined in G.S. 130A-283 at permit valid until County Expiration Date This permit is not transferable
to any other person or place of practice. Place of Practice Tattoo Artist ID Number 2 0 1 8 6 1 0 1 1 3 Timothy Bartles II Tattoo Laboratory, 1752 Startown Rd, Hickory, NC 28602 Catawba
08/02/2012
Purpose: General Statute 130A-283 states "No person shall engage in tattooing without first obtaining a tattooing permmi from the Department". The permit is issued to a tattoo artist
who meets all requirements of Rules Governiin Tattooing 15 NCAC 18A .3200. The permit is not transferable to any other person or place of practice and is valid for a period of one year.
This form is to be used as the permit as specified above. Preparation: Local environmental health specialist shall issue a permit every time a permit issuance is indicated. Prepare an
original and one copy for: 1. Original to tattoo artist 2. Copy for the local health department Disposition: Please refer to Records Retention and Disposition Schedule for County/District
Health Departments which is published by the North Carolina Division of Historical Resources. Additional forms may be ordered from: Division of Environmental Health 1632 Mail Service
Center Raleigh, NC 27699-1632 (Courier 52-01-00) DENR 4016 (Revised 7/05) Environmental Health Services Section