Laserfiche WebLink
' }...,. City/ county <br /> Mailing AddressWaste ire Surveyand Inspection Report <br /> Phone Number <br /> State of California <br /> CIWMB-54(10/03) <br /> PART D -Notes <br /> Page of <br /> File Number: Inspection Date: <br /> Businessl Facility Name: GPS Coordinates: <br /> TS <br /> �\ Y1 J <br /> G�CiI I 1A US T1 C t/� i IC-1- W ICS G. l <br /> o 4- A CC-e-sS r -}'a 1 e-:, s,=nn S c <br /> k% o ►� r_c e S fes. S <br /> �a 1 c rLTt~iG2r.-, I v PSS �,c KS . <br /> 1 <br /> Follow-up: <br /> ❑ Letter of Violation Violation re-inspection ❑ Refer to CIWMB Date: <br /> Date Mailed: Date: 21 U <br /> yr !ti ❑ Other Referrals <br /> ❑ If this box checked NFA required. ❑ No tires, remove. ❑ Out of business, remove. <br /> Inspector's Signature Phone: <br /> White Copy: CIWMB Yellow Copy: Operator Blue Copy: LEA <br />