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ENVIRONMENTAL HEALTH <br /> SAN JOAQUIN COUNTY <br /> Waste Tire Survey and Inspection Repor . 304 E WEBER AVE 3"D FL <br /> STOCKTON CA 95202-2708 <br /> eofCalifomia (209) 468-3420 <br /> MB-54(10/03) <br /> RT D -NotesPage 0f2� <br /> ile Number: Inspection ]Date* <br /> 3 <br /> usinessf Facility Name: GPS Coordinates: <br /> Leyr')A� <br /> • s a, l� 4-4 &7AaL <br /> l i ss <br /> "P: ❑ Refer to COMB Date: <br /> ❑ Datation re inspectionDate: <br /> ❑ Other Referrals <br /> No tires, remove. ❑ Out of business, remove. <br /> FA required. ❑ <br /> Phone: <br /> Llns:pe:c:tor'sSignatu _�3Z <br /> White Copy: CIWMB Yellow Copy: Operator Blue Copy: LEA <br />