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ENVIRONMENTAL HEALTH <br /> SAN JOAQUIN COUNTY <br /> Waste t ire Survey and Inspection Repo, . 304 E WEBER AVE 3' FL <br /> STOCKTON CA 95202-2708 <br /> State of California (209) 468-3420 <br /> CIWMB-54(10/03) <br /> PART D -Notes Page —2-of <br /> File Number: Inspection Date: <br /> S <br /> Business/Facility N me: C GPS Coordinates: <br /> SJ <br /> 54e__ " 6 <br /> 1 'Z5; <br /> i <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 /> / Ll <br /> Inspector's Signature Phone: �—Z�� <br /> White Copy: CIWMB Yellow Copy: Operator Blue Copy: LEA <br />