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CI Coun y <br /> Waste Tire Survey and Inspection Repor Mai ingAdffess <br /> i=: Phone:`umber <br /> tate of califomia <br /> IWMB-54(10/03) <br /> 'ART D -Notes 0 Page ofz <br /> File Number: Inspection te: <br /> /2 �3 <br /> Business/ Fac i ity Name: GPS Co rdi tes: <br /> r� <br /> 1 , An&L `�` <br /> Z \ LC 1 B� �• v��vv`e �s � <br /> .� CA,1n/✓� - <br /> Ob <br /> C— <br /> • - � � t � (`��.. `moi 7�S <br /> v.d. <br /> I <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 Signa Phone: <br /> White Copy: LAW Mb Yellow Copy: Operator Blue Copy: LEA <br />