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ENVIRONMENTAL HEALTH <br /> SAN JOAQUIN COUNTY <br /> :A <br /> Waste 'i ire Survey and Inspection Repor 304 E WEBER AVE 3P'D FL <br /> STOCKTON CA 95202-2708 <br /> State of California <br /> CIWMB-54(10/03) (209) 468-3420 <br /> PART D -Notes Page"�' f � <br /> File Number: Inspection Date: <br /> Z5 <br /> Business/ Facility Name GPS Coordinates: <br /> h <br /> LKY-b <br /> L <br /> r ' - e <br /> t <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 tires, remove. ❑ Out of business, remove. <br /> Inspector's Signature Phone: <br /> White Copy: CIWMB Yellow Copy: Operator Blue Copy: LEA <br />