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ENVIRONMENTAL HEALTH <br /> :A SAN JOAQUIN COUNTY <br /> Waste 'l ire Survey and Inspection Repo 1 304 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 Pagea,-of Z <br /> File Number: Inspection Date: <br /> j <br /> Business/ Facility Name: GPS Coordinates: <br /> f <br /> h/T <br /> e — <br /> I r <br /> ds s <br /> Lo <br /> 1 / <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 <br /> White Copy: CIWMB Yellow Copy: Operator Blue Copy: LEA <br />