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AWaste fire Surve and Ins ection Re ort City/County <br /> 3' p p Mailing Address <br /> State of California Phone Number <br /> CIWMB-54(10/03) <br /> PART D -Notes Page—of 2� <br /> File Number: Inspection Date:3 <br /> Business/ Facility Name: GPS Coordinates: <br /> 2 <br /> O/�rh✓H lt✓I`7 IS M,,,;4;13 49 <br /> — C t7 <br /> E u w;IL — <br /> v.'L Ge- N z7 r. <br /> G ,5: -G4, 1 G LA) GJ� <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: �-z��� <br /> White Copy: CIWMB Yellow Copy: Operator Blue Copy: LEA <br />