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w <br /> and Inspection Re city/county <br /> i e <br /> Waste Survey a p p or Mailing Address <br /> WN: Phone Number <br /> ,tate of Califomia <br /> AWMB-54(10/03) <br /> 'ART D-Notes �v 1 �^'� -'� - Page aof /1 <br /> File Number: Inspection ate: <br /> Z G <br /> Business/Fa 'lity N e: GPS Co rdin tes: <br /> �G ✓iGe— <br /> a irLs�e o� �✓' 1-tf� <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 Signatu Phone:),qui -S'53-762 f <br /> White Copy:CIWMB Yellow Copy: OperatorBlue Copy: LEA <br />