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ENVIRONMENTAL HEALTH <br /> SAN JOAQUIN COUNTY <br /> Waste 't ire Survey and Inspection Repon 304 E WEBER AVE 3' FL <br /> : <br /> STOCKTON CA 95202-2708 <br /> State of California <br /> CIWMB-54(10/03) (209) 468-3420 <br /> PART D - Notes Page IfTf 2— <br /> File Number: Inspection Date: <br /> Business/ Facility Name: GPS Coordinates: <br /> a1;,:5— <br /> Lao, <br /> � ' l <br /> r <br /> --1-- !2-2 <br /> 4-5 V116 1 41-41 <br /> (� r necQ <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: l 6lK'21 �b <br /> tZ, <br /> White Copy: CIWMB Yellow Copy: Operator Blue Copy: LEA <br />