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Waste Survey and Inspection Repo, <br /> City/county <br /> AMaiimg Address <br /> ��".r h p �i'.� ��v. �-y �hV, Cs. -� �,,,.�-- Phone Number <br /> State of California !,- ✓`�' <br /> CIWMB-54(10/03) L+ ��' 1_ �e-,- )9UC_ <br /> PART D -NotesPage 7—of 2— <br /> File Number: Inspection Date: <br /> Business/Facility Name:_ GPS Coo dina s: <br /> — Is- <br /> S kle- <br /> -Z c. �. S <br /> 4• <br /> k-, <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 Signature Phone: <br /> White Copy: CIWMB Yellow Copy: Operator Blue Copy: LEA <br />