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MENVIRONMENTAL HEALTH <br /> Waste fire Surveyand Inspection Rep"t SAN WEBERAQUIN COUNTY <br /> Jug- p 304 E WEBER AVE 3� FL <br /> ate of California STOCKTON CA 95202-2708 <br /> :IWMB-54(10/03) (209) 468-3420 <br /> SART D - Notes Page�-of Z <br /> File Number: Inspection Da e: <br /> s y v <br /> Bu=0V <br /> s/ Facility Name: GPS Coord nat s: <br /> �\�os <br /> �rw-r \1 TV Vlad. <br /> n)T <br /> (� N <br /> T�\ OV& <br /> i <br /> Follow-up: <br /> I ❑ Letter of Violation ❑ Violation re-inspection ❑ Refer to CIWMB Date: <br /> Date Mailed: Date: <br /> F1 Other Referrals <br /> ❑ If this box checked NFA required. ❑ No tires, remove. ❑ Out of business, remove. <br /> Inspector's Signature Phone: Rs�1 55� 7 <br /> White Copy: CIWMB Yellow Copy: Operator Blue Copy: LEA <br />