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ENVIRONMENTAL HEALTH <br /> SAN JOAQUIN COUNTY <br /> Waste Tire Survey and 10Inspection Report 304 E WEBER AVE 3� FL <br /> STOCKTON CA 95202-2708 <br /> State of California <br /> CIWMB-54(10/03) (209) 468-3420 <br /> PART D -Notes Page -2,of�� <br /> File Number: Inspection Date: <br /> Business/ Facility Name: GPS Coordinates: <br /> ,S <br /> C2:7-;:,3 r >,-> <br /> f.�J4• /'t/t=QLJej CA 4- <br /> V <br /> •-rt-� `�-.mss. <br /> �1t7 �la a C1 r)eF 5 <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: `7 606- <br /> White Copy: CIWMB Yellow Copy: Operator Blue Copy: LEA <br />