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City/County <br /> ey and Inspection Report Mailing Address <br /> e of Celifomia Phone Number <br /> 'MB-54(10/03) <br /> RT D - Notes �/ � �' .� _ �� Page 20 <br /> le Number: Inspection Date: <br /> usiness/ Facilltv-Name: GPS Coordinates: <br /> 71, <br /> 76P <br /> 01 %� �r� /SSS•i %,� � -.- '`� <br /> /6" r2�y <br /> 1735% <br /> =ollow-up: <br /> ❑ Letter of Violation zalviolatio re-inspection E] Refer to CIWMB Date: <br /> Date Mailed: Date: 25 <br /> ❑ Other Referrals <br /> ❑ If this box checked NFA required. [] No tires, remove. ❑ Out of business, remove. <br /> nspector's Signator Phone: <br /> White Copy: CIWMB Yellow Copy: Operator Blue Copy: LEA <br /> - <br /> , <br />