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ENVIRONMENTAL HEALTH <br /> SAN JOAQUIN COUNTY <br /> Waste Tire Survey and Inspection Report 304 E WEBER AVE 3RD FL <br /> STOCKTON CA 95202-2708 <br /> Stdte of California <br /> CIWMB-54(10/03) (209) 468-3420 <br /> PART D -Notes Page 7--of "2— <br /> File <br /> File Number: Inspection Date: <br /> O <br /> Business/ Facility Name: GPS Coordinateg: <br /> �.Gi rl iS ti i <br /> 11A v, <br /> 4►� 11" <br /> Fla- <br /> i o <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: Z <br /> White Copy: CIWMB Yellow Copy: Operator Blue Copy: LEA <br />