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R . <br /> .... city/county <br /> asteireurve anecone or <br /> Mailing Address <br /> Phone Number <br /> ate of Califomia <br /> NMB-54(10/03) <br /> 4RT D -Notes Pagegof--4 <br /> =ile Number: Inspection Date: <br /> 3usiness/Facili � <br /> Name: GPS Coordinates: <br /> / - <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 Signa re ���/6� Phonet�O9 <br /> White Copy: CIWMB Yellow Copy: Operator Blue Copy. LEA <br />