Laserfiche WebLink
ICity/County <br /> Waste Tire Survey and Inspection Report Mailing Address <br /> of California Phone Number <br /> 'MB-54(10/03) <br /> RT D -Notes Page_ f ' <br /> le Number: Inspection D e: <br /> usiness/ Facility Na GPS Coordinates: <br /> J <br /> =ollow-up: <br /> ❑ Letter of Violation [] Violati n r inspecti n ❑ Refer to CIWMB Date: <br /> Date Mailed: -Dat <br /> ❑ Other Referrals <br /> ❑ If this box checked NFA required. ❑ No tires, remove. ❑ Out of business, remove. <br /> nspector's Signature f2a Phond5)L6 �3/�� <br /> ('White Copy: CIWMB Yellow Copy: Operator Blue Copy: LEA <br />