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ENVIRONMENTAL HEALTH <br /> Waste Tire Surveyd Inspection Re oOr <br /> SAN JOAQUIN covrrT <br /> � <br /> anns Pecon p 304 E WEBER AVE 3 FL <br /> :ale ofCalifomia STOCKTON CA 95202-2708 <br /> ;V.'Ya-54(10/03) (209) 468-3420 <br /> 'ART D - Notes _ _ Page of <br /> File Number: Inspection Pate- <br /> Business/ Facility Name: GPS Cootdinates: <br /> A tAv r <br /> �l n� w�a��-��;— Su.nvq� ��l v�Je�tT'e✓� 'tom <br /> �\ t <br /> T G r.l►Y/j• �no►�. _T P t 1!e) <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. El Out of business, remove. <br /> Inspector's Signatur Phone: y"S 3 765 <br /> White Copy: CIWMB Yellow Copy: Operator Blue Copy: LEA <br />