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r City/County <br /> WasteirSurvey and Inspection Rep Mailing Address <br /> i:i::2 �: Phone Number <br /> tate of Califomia <br /> IWMB-54(10/03) <br /> Page <br /> 'ART D -Notes <br /> File Number: Inspecti n Da <br /> � z� D <br /> Busi s/Facility�e: GP Coord nates: — <br /> IlLit <br /> if U <br /> -�- - ` - <br /> 'a'OL= <br /> II <br /> Follow-up: <br /> F] 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 Si re Phone: azti `ls Zkl'/P <br /> Whit CIWMB Yellow Copy: Operator Blue Copy: LEA <br />