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ENVIRONMENTAL HEALTH <br /> _ SAN JOAQUIN COUNTY <br /> Waste Tire Survey and Inspection Report 304 E WEBER AvE 3' FL <br /> STOCKTON CA 95202-2708 <br /> of California (209) 468-3420 <br /> ,,AB-54(10/03) <br /> ,)ART D - Notes Page 2--of Z <br /> File Number: Inspection Date: <br /> O <br /> Business/ Facility Name: GPS Coordinate : <br /> co 1 P) d_5 <br /> ' 4� <br /> 141— m i o <br /> r� _ c i <br /> r < <br /> Follow-up: <br /> ❑ Letter of Violation ❑ Violation re-inspection ❑ Refer to CIWMB Date: <br /> Date Mailed: Date: <br /> ❑ Other Referrals <br /> ❑ If this box checked NFA required. ❑ No fires, remove. ❑ Out of business, remove. <br /> Inspector's Signature <br /> Phone: <br /> E <br /> White Copy: CIWMB Yellow Copy: Operator Blue Copy: LEA <br />