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City/County <br /> .. <br /> Waste _.re Survey and Inspection Repo Mailing Address <br /> State of California <<•— vG �1^ �_ �.^�, �1�1>/ � 1. L Phone Number <br /> CIWMB-54(10/03) / <br /> PART D - Notes Page 7of?-- <br /> File Number: Inspection Date: . <br /> Business/Facility Name: GPS Coordinates: <br /> 1c-LJ ;hT <br /> :r c> 15 1 0 -7 CK <br /> n <br /> erX 6A <br /> be- <br /> I rr vim.(s V -F- LA re <br /> V� 1 <br /> c"j <br /> th <br /> V N 4-5; <br /> 10 0�}- <br /> / U <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 Signatur 6Phone: 4big 19 2� <br /> White Copy: CIWMB Yellow Copy: Operator Blue Copy: LEA <br />